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Development and validation of two novel antibiotic use metrics suitable for facilities and practitioners in post-acute and long-term care settings

Published online by Cambridge University Press:  26 March 2025

Sunah Song ,
Brigid Wilson ,
Taissa A. Bej ,
Corinne Kowal ,
Federico Perez ,
David A. Nace ,
Taylor Boyer ,
Katie J. Suda ,
Charlesnika T. Evans  and
Aoife Fleming
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Sunah Song
Affiliation:
Cleveland Institute for Computational Biology, Case Western Reserve University School of Medicine, Cleveland, OH, USA Geriatric Research Education and Clinical Center (GRECC), VA Northeast Ohio Healthcare System, Cleveland, OH, USA
Brigid Wilson
Affiliation:
Geriatric Research Education and Clinical Center (GRECC), VA Northeast Ohio Healthcare System, Cleveland, OH, USA Division of Infectious Diseases & HIV Medicine in the Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, OH, USA
Taissa A. Bej
Affiliation:
Geriatric Research Education and Clinical Center (GRECC), VA Northeast Ohio Healthcare System, Cleveland, OH, USA
Corinne Kowal
Affiliation:
Geriatric Research Education and Clinical Center (GRECC), VA Northeast Ohio Healthcare System, Cleveland, OH, USA
Federico Perez
Affiliation:
Geriatric Research Education and Clinical Center (GRECC), VA Northeast Ohio Healthcare System, Cleveland, OH, USA Division of Infectious Diseases & HIV Medicine in the Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, OH, USA
David A. Nace
Affiliation:
Division of Geriatrics, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
Taylor Boyer
Affiliation:
Center for Health Equity Research and Promotion (CHERP) VA Pittsburgh Healthcare System, Pittsburgh, PA, USA
Katie J. Suda
Affiliation:
Division of Geriatrics, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA Center for Health Equity Research and Promotion (CHERP) VA Pittsburgh Healthcare System, Pittsburgh, PA, USA
Charlesnika T. Evans
Affiliation:
Center of Innovation for Complex Chronic Healthcare, Edward Hines, Jr VA Hospital, Hines, IL, USA Center for Health Services and Outcomes Research, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
Aoife Fleming
Affiliation:
Pharmaceutical Care Research Group, School of Pharmacy, University College Cork, Cork, Ireland Pharmacy Department, Mercy University Hospital, Cork, Ireland
Robin L.P. Jump*
Affiliation:
Division of Geriatrics, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA Center for Health Equity Research and Promotion (CHERP) VA Pittsburgh Healthcare System, Pittsburgh, PA, USA Geriatric Research Education and Clinical Center (GRECC), VA Pittsburgh Healthcare System, Pittsburgh, PA, USA
*
Corresponding author: Robin L.P. Jump; Email: [email protected]
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Abstract

Objective:

Many post-acute and long-term care settings (PALTCs) struggle to measure antibiotic use via the standard metric, days of therapy (DOT) per 1000 days of care (DOC). Our objective was to develop antibiotic use metrics more tailored to PALTCs.

Design:

Retrospective cohort study with a validation cohort.

Setting:

PALTC settings within the same network.

Methods:

We obtained census data and pharmacy dispensing data for 13 community PALTCs (January 2020–December 2023). We calculated antibiotic DOT/1000 DOC, DOT per unique residents, and antibiotic starts per unique residents, at monthly intervals for community PALTCs. The validation cohort was 135 Veterans Affairs Community Living Centers (VA CLCs). For community PALTCs only, we determined the DOT and antibiotics starts per unique residents cared for by individual prescribers.

Results:

For community PALTCs, the correlation between facility-level antibiotic DOT/1000 DOC and antibiotic DOT/unique residents and antibiotic courses/unique residents was 0.97 (P < 0.0001) and 0.84 (P < 0.0001), respectively. For VA CLCs, those values were 0.96 (P < 0.0001) and 0.85 (P < 0.0001), respectively. At community PALTCs, both novel metrics permitted assessment and comparison of antibiotic prescribing among practitioners.

Conclusion:

At the facility level, the novel metric antibiotic DOT/unique residents demonstrated strong correlation with the standard metric. In addition to supporting tracking and reporting of antibiotic use among PALTCs, antibiotic DOT/unique residents permits visualization of the antibiotic prescribing rates among individual practitioners, and thus peer comparison, which in turn can lead to actionable feedback that helps improve antibiotic use in the care of PALTC residents.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , First View , pp. 1 - 7
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Copyright
© The Author(s), 2025. Published by Cambridge University Press on behalf of The Society for Healthcare Epidemiology of America

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Footnotes

Previous Presentation: Some of the content reported in this manuscript was presented as an oral abstract at SHEA 2024, Houston TX.

References

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