Use of Diagnosis-related Group-Based Days of Therapy to Evaluate Fluoroquinolone Use Optimization Across a Large Healthcare System

Abstract

BackgroundOptimal use of fluoroquinolones (FQ) is a common antimicrobial stewardship program (ASP) target based on well-cited risk for Clostridium difficile colitis and has gained national attention in the setting of recent FDA warnings about serious side effects. Identifying appropriate metrics for benchmarking poses a significant challenge. Diagnosis-related group (DRG) can be leveraged to focus large volumes of patient data to derive DRG-based days of therapy (DOT). Novant Health identified an opportunity to improve FQ use among patients with COPD and pneumonia (PNA) across the health system and created a FQ use optimization initiative based on inter-facility data that would otherwise not have been possible using the standard DOT per 1000 patient-days (PD) metric.MethodsA staged approach to optimizing FQ use was developed through a multidisciplinary, system-level ASP, and system-specific benchmarks for FQ use among patients with PNA and COPD DRGs were established. 10 facilities ranging in size from 60 to 900 beds were included in the intervention. We evaluated FQ use at the system and facility level using both standard (DOT/1000 PD) and novel metrics (DRG-specific DOT/1000 PD and percentage of antibiotic use attributed to FQ within each DRG). In addition to providing feedback on performance relative to other facilities, the intervention also included provider education and targeted infectious diseases pharmacist review and feedback.ResultsPercentage of FQ use among patients with PNA DRGs decreased from 20% to 9%, while use in COPD DRGs decreased from 38% to 12% over 15 months (55% and 68% reductions in FQ use, respectively). System-wide FQ utilization decreased by 38% over the same 15 month time period, from a peak of 114 DOT/1000 PD to 71 DOT/1000 PD.ConclusionDecreases in overall FQ utilization were influenced by DRG-specific benchmarking and inter-facility comparisons. Traditional DOT/1000 PD metrics are plagued with variance in patient characteristics (e.g., disease state variations, severity of illness). While DRG-based metrics have inherent limitations, they can provide specific data on antibiotic use patterns to support health-system specific and evidence-based benchmarking and inter-facility comparisons.Disclosures All authors: No reported disclosures.