Measuring Implementation of Antibiotic Stewardship in Critical Access Hospitals Using the NHSN Annual Facility Survey

Abstract

Background: Critical access hospitals (CAHs) serving rural communities have numerous limitations regarding resources, infrastructure, and staffing to support antibiotic stewardship programs (ASPs) and related quality improvement activities. The Federal Office of Rural Health Policy (FORHP) established the Medicare Beneficiary Quality Improvement Project (MBQIP) to provide CAHs with specialized technical assistance in quality improvement data collection and reporting to drive improvements in the quality of care and to reduce barriers to establishing ASPs. In 2016, FORHP developed an antibiotic stewardship process measure in partnership with the CDC to assess progress on implementing ASPs and to optimize hospital quality improvement practices related to antibiotic use. This is the first measure to be successfully implemented and reported at a national level to improve the judicious use of antibiotics in hospitals. Methods: A process measure was developed to assess adherence to the 7 core elements of a successful hospital ASP (ie, leadership, accountability, drug expertise, action, tracking, reporting, and education), as defined by CDC guidelines. Implementation was accomplished through CAH participation in the NHSN Annual Facility Survey (AFS). Responses were analyzed to assess fidelity to each core element, to identify trends, and to benchmark measure reporting among 1,350 CAHs across the United States. Responses were mapped to 7 core element categories, and the total number of positive responses were matched to each core element for a specific survey year to track progress. Overall, the measure assessed progress in meeting all 7 core elements, as well as program robustness in the number of actions implemented and the amount of data tracked and reported at each hospital. NHSN reports were generated to tailor technical assistance activities and to assist hospitals with measure uptake and reporting. Results: CAH participation in the NHSN significantly increased from 2014 to 2018 (83% response rate). From 2014 through 2018, reporting of the new antibiotic stewardship measure consistently increased. CAHs that met all core elements increased from 18% (2014) to 73% (2018). Performance-based benchmarks enabled hospital comparisons and the establishment of reporting goals. Conclusions: This study highlights viable approaches to measuring antibiotic stewardship at a national level to drive improvements in care at hospitals of any size. The implementation of the antibiotic stewardship measure across CAHs demonstrates the impact of federal programs like MBQIP for hospitals that are building capacity for quality improvement. For the first time, CAHs were able to measure and compare their implementation of ASPs to other hospitals at the state and national level.Funding: NoneDisclosures: None