TY - JOUR
T1 - Longitudinal evaluation of a World Wide Web-based antimicrobial stewardship program
T2 - Assessing factors associated with approval patterns and trends over time
AU - Venugopal, Vidya
AU - Lehmann, Christoph U.
AU - Diener-West, Marie
AU - Agwu, Allison L.
N1 - Funding Information:
A.L.A. was supported by the Johns Hopkins Ross Clinician Scientist Award , and a grant from the National Institute of Allergy and Infectious Diseases ( 1K23AI084549 ). C.U.L. is employed by the American Academy of Pediatrics.
Copyright:
Copyright 2014 Elsevier B.V., All rights reserved.
PY - 2014/2
Y1 - 2014/2
N2 - Background The Johns Hopkins Children's Medical and Surgery Center developed a Web-based Antimicrobial Stewardship Program (ASP) in 2005. The present study aimed to assess longitudinal antimicrobial request and approval patterns for this ASP. Methods We analyzed a total of 16,229 antimicrobial requests for 3,542 patients between June 1, 2005, and June 30, 2009. Antimicrobial approval was the outcome of interest. We assessed gaming by studying trends in automatically approved requests. Nonparametric tests for trend were performed to detect changes in approval patterns. Multiple logistic regression was used to identify factors associated with approval. Results The vast majority (91.3%) of antimicrobial requests were approved, with an increase of 6.1% over time (P <.01). Renewal requests were more likely than primary requests (adjusted odds ratio [aOR], 1.72; 95% confidence interval [CI], 1.45-2.04) to be approved. Antiviral requests had higher odds of approval than antibiotic requests (aOR, 1.27; 95% CI, 1.04-1.56). Compared with requests by medical services, requests by surgical services had lower odds of approval (aOR, 0.70; 95% CI, 0.59-0.83), whereas pediatric intensive care requests had higher odds of approval (aOR, 1.18; 95% CI, 1.00-1.40). The number of auto-approved requests remained consistent. Conclusions The Web-based ASP allows management of a large number of antimicrobial requests, without apparent gaming. Observed differences in approval patterns based on patient, requestor, and antimicrobial factors may inform the development of ASPs and evaluation of provider education and training.
AB - Background The Johns Hopkins Children's Medical and Surgery Center developed a Web-based Antimicrobial Stewardship Program (ASP) in 2005. The present study aimed to assess longitudinal antimicrobial request and approval patterns for this ASP. Methods We analyzed a total of 16,229 antimicrobial requests for 3,542 patients between June 1, 2005, and June 30, 2009. Antimicrobial approval was the outcome of interest. We assessed gaming by studying trends in automatically approved requests. Nonparametric tests for trend were performed to detect changes in approval patterns. Multiple logistic regression was used to identify factors associated with approval. Results The vast majority (91.3%) of antimicrobial requests were approved, with an increase of 6.1% over time (P <.01). Renewal requests were more likely than primary requests (adjusted odds ratio [aOR], 1.72; 95% confidence interval [CI], 1.45-2.04) to be approved. Antiviral requests had higher odds of approval than antibiotic requests (aOR, 1.27; 95% CI, 1.04-1.56). Compared with requests by medical services, requests by surgical services had lower odds of approval (aOR, 0.70; 95% CI, 0.59-0.83), whereas pediatric intensive care requests had higher odds of approval (aOR, 1.18; 95% CI, 1.00-1.40). The number of auto-approved requests remained consistent. Conclusions The Web-based ASP allows management of a large number of antimicrobial requests, without apparent gaming. Observed differences in approval patterns based on patient, requestor, and antimicrobial factors may inform the development of ASPs and evaluation of provider education and training.
KW - Antibiotic requests
KW - Approvals
KW - Outcomes
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U2 - 10.1016/j.ajic.2013.09.018
DO - 10.1016/j.ajic.2013.09.018
M3 - Article
C2 - 24485366
AN - SCOPUS:84893158382
SN - 0196-6553
VL - 42
SP - 100
EP - 105
JO - American Journal of Infection Control
JF - American Journal of Infection Control
IS - 2
ER -