Department of Pharmacotherapy and Outcome Science, School of Pharmacy, Virginia Commonwealth University, Richmond, USA.
Clin Infect Dis. 2011 Dec;53(11):1100-10. doi: 10.1093/cid/cir672. Epub 2011 Oct 13.
Antimicrobial stewardship programs are advised to measure and risk-adjust antimicrobial use to facilitate interhospital comparisons, a process called benchmarking. The purpose of this investigation was to evaluate a new benchmarking strategy for antibacterials.
Hospital-wide adult antibacterial drug use in 2009 was measured as days of therapy (DOT) and length of therapy (LOT) from billing records in 70 US academic medical centers (AMCs). Patients were assigned to 1 of 35 clinical service lines (CSL) based on their Medicare Severity Diagnosis Related Group. Expected (E) use was determined by indirect standardization and compared with observed (O) use.
Of 1,791 ,180 discharged adults, 63.7% received antibacterial drugs; the range by CSL was 14.3% (psychiatry) to 99.7% (lung transplant). Mean ± SD hospital-wide use was 839 ± 106 DOTs (range, 594-1109) and 536 ± 53.0 LOT (range, 427-684) per 1000 patient-days. The ventilator support CSL had the most DOT per discharge, 39.4 ± 9.4 days; the LOT was 21.5 ± 4.5 days. The hospital-wide O/E ratio range was 0.7-1.45; in 5 AMCs the ratio exceeded the 90% confidence interval (CI) and was below the 90% CI in 6. Variability in use was explained by the proportion of treated patients within each CSL and mean LOT and DOT per discharge.
Adult antibacterial drug use was benchmarked to expected use adjusted for patient mix, and outlier hospitals were identified. Differences between expected and observed use reflect usage patterns that were benchmarked and are targets for evaluation and intervention.
抗菌药物管理计划建议衡量和风险调整抗菌药物的使用，以促进医院间的比较，这一过程称为基准化。本研究旨在评估一种新的抗菌药物基准化策略。
从 70 家美国学术医疗中心的计费记录中测量了 2009 年全院成人抗菌药物的使用情况，以治疗日（DOT）和治疗时长（LOT）表示。根据其医疗保险严重程度诊断相关组，将患者分配到 35 个临床服务线（CSL）之一。通过间接标准化确定预期（E）使用量，并与观察（O）使用量进行比较。
在 1791000 名出院的成年人中，有 63.7%接受了抗菌药物治疗；CSL 的范围为 14.3%（精神病学）至 99.7%（肺移植）。全院范围内的平均使用量为 839±106DOT（范围为 594-1109）和 536±53.0LOT（范围为 427-684）/1000 患者天。有呼吸机支持的 CSL 每出院患者的 DOT 最多，为 39.4±9.4 天；LOT 为 21.5±4.5 天。全院范围内 O/E 比值范围为 0.7-1.45；在 5 家医疗中心，该比值超过了 90%置信区间（CI），而在 6 家医疗中心则低于 90%CI。使用的可变性由每个 CSL 中治疗患者的比例以及每个出院患者的平均 LOT 和 DOT 来解释。
对成人抗菌药物使用进行了基准化，以调整患者组合的预期使用，并确定了异常值医院。预期和观察到的使用之间的差异反映了经过基准化的使用模式，这些模式是评估和干预的目标。
