Blog from January, 2020

Aviva Bodek


Antibiotic resistance is one of the greatest threats to global health today. In the U.S. alone, more than 2.8 million antibiotic-resistant infections occur each year, and more than 35,000 people die as a result. This translates to a death every 15 minutes as a result of an antibiotic-resistant infection. Future projections suggest that by 2050, 10 million mortalities a year will result from antibiotic-resistant bacteria, leading to a 2 to 3.5% reduction in Gross Domestic Product and costing the world up to $100 trillion.

Antibiotic resistance occurs naturally, but overuse of antibiotics is drastically accelerating the process. Reducing the profligate use of antibiotics is a crucial element in preventing further bacterial resistance from emerging.
 

Reducing Antibiotic Use in the Hospital

Hospital antibiotic stewardship programs (ASPs) can reduce inappropriate antibiotic use and are now a mandatory entity in all U.S. hospitals. The new rule from the Centers for Medicare & Medicaid Services (CMS) dictates that all hospitals will be required to have infection prevention and control and stewardship programs in place by March 30, 2020 in order to receive payments from the agency. Hospital accrediting bodies such as The Joint Commission have required antibiotic stewardship programs in hospitals since 2017.
 
An ASP is designed to provide guidance for the safe and cost-effective use of antibiotic agents. This evidence-based approach addresses the correct selection of antibiotic agents, dosages, routes of administration and duration of therapy. Such programs not only decrease antibiotic resistance, adverse drug events and hospital length of stay, but they can also save money for healthcare institutions. A University of Maryland study, for example, showed $3 million in cost savings in the first three years of an ASP.

According to the CDC, 20 to 50% of antibiotic use is unnecessary and inappropriate. While preventing infections is the first defense against antibiotic resistance, perhaps the single most important action needed to greatly slow down the development and spread of antibiotic-resistant infections is to change the way antibiotics are prescribed.

Examples of interventions to prevent overuse or overprescribing of antibiotics in hospitals include:

  • Use of rapid diagnostic testing
  • Restricting broad-spectrum antibiotics
  • Shortening the duration of therapy through automatic stop orders
  • Basing treatment on patient pharmacokinetic and pharmacodynamic characteristics
  • Developing institution-specific treatment guidelines
  • Therapeutic review with comprehensive feedback and provider education.


Leveraging Technology to Optimize Antibiotic Therapy

With so many components to a successful ASP, technology, such as clinical decision support systems (CDSSs) is critical to maximize program efficiency and effectiveness. Based on a sophisticated set of customizable rule engines, CDSSs can provide prompts and reminders to assist healthcare providers in implementing evidence-based clinical guidelines at the point of care.

CDSSs operate by continuously monitoring patient data to alert clinicians in real time of potential infections, drug-bug mismatches, multidrug-resistant organisms, isolation candidates, test results and reportable infections. These alerts help to identify patients for potential interventions. Several studies have demonstrated that CDSS implementation increases the number of antibiotic interventions that can be made by as much as 87%.  A significant time reduction in both de-escalation and escalation to appropriate antibiotic therapy has also been demonstrated.

Customization of the electronic health record (EHR) is another electronic tool that can bolster an ASP program. EHR capabilities may include tracking interventions, dose checking alerts, best practice guided order sets, antibiotic time-outs, antibiotic restriction processes, intravenous to oral conversion monitoring and tracking antibiotic prescribing practices.
 

Reporting on Facility and State Improvements

Technology can also be a major asset for the electronic reporting of antibiotic use and antibiotic resistance data to the Centers for Disease Control and Prevention’s National Healthcare Safety Network (NHSN). Although currently voluntary, NHSN antibiotic use and/or antibiotic resistance reporting has been identified as one option for eligible hospitals to meet Public Health Registry reporting criteria under Stage 3 of the CMS Meaningful Use (MU3) Program. The information must be submitted electronically in Health Level Clinical Document Architecture format. Manual data entry is not available for the Antibiotic Use and Resistance Module.

Collecting, analyzing and reporting data on antibiotic use and then using that information to improve prescribing practices is the foundation of a successful ASP leading to decreased antibiotic resistance. Technology such as CDSSs and EHR customization not only enables program metric tracking and reporting, it allows an ASP to reach a larger patient population and optimize resource utilization.


Jessica Kent


Through a donation from Millennium Health, HHS will leverage real-time data to develop targeted approaches to fighting the opioid crisis.


The Department of Health and Human Services (HHS) has announced an agreement with Millennium Health, an accredited specialty laboratory, to combat the opioid crisis using near real-time drug testing data.

Millennium Health’s Emerging Threat Intelligence Program will donate data that includes regular reporting of drug use trends from definitive urine drug test results obtained from all 50 states, the District of Columbia, and multiple medical practice types that can identify community level indicators of illicit drug use.

The de-identified and aggregate data will enable enhanced surveillance and analysis of emerging drug use trends, allowing officials to spot patterns and target drug use interventions.

In a report published in JAMA Network Open on January 3, 2020, researchers evaluated Millennium Health data and found a sharp rise in the use of methamphetamine and increases in stimulant-involved overdose deaths. Since 2016, rates of positive urine drug test results have increased by 42.44 percent for methamphetamine and 75.46 percent for fentanyl.

The results also showed that among urine drug test results positive for fentanyl, methamphetamine positivity continued to increase by 153.51 percent.

Researchers highlighted the significant role that near real-time data could play in combating these trends.

“Nontraditional data sources, including urine drug tests, may provide a more timely estimation of emerging drug use prior to the reporting of drug overdose deaths. Earlier identification of these trends supports the development of targeted interventions to curb the effect of drug abuse on public health,” the report authors said.

Other organizations have recognized the benefits of using real-time data to track and monitor illicit drug use. The New Jersey Institute of Technology (NJIT) recently developed a real-time data analytics tool that helps treatment centers and counselors identify and treat drug abuse. The tool monitors online platforms like Twitter and Reddit and combines this information with geospatial data to find out where users are obtaining drugs, as well as trends or changes in drug use.

The Millennium Health data donation will build on HHS’ efforts to curb the effects of the opioid epidemic. In August 2019, the agency partnered with the Healthcare Resources and Services Administration (HRSA) to award nearly $400 million in grants to expand patient access to opioid treatment in rural communities and other medically underserved areas.

“Health centers and behavioral health providers are on the front lines of the fight against the opioid crisis and substance abuse, especially in rural communities,” HHS Secretary Alex Azar said in a statement.

“With our evidence-based strategy, HHS is working to support local communities in fighting back against substance abuse, and our united efforts are yielding results. Together, we can end our country’s opioid crisis and lay a foundation for a healthier country where every American can access the mental healthcare they need.”

The new agreement with Millennium Health will give HHS access to timely data that can support the development of focused healthcare services at state and local levels. HHS expects that the collaboration will result in services that can prevent drug overdoses, reverse non-fatal overdoses, and engage individuals in treatment.

“The Trump Administration recognizes the power of current data in the multi-pronged efforts to curb the drug overdose epidemic. With frequent reporting of drug testing data, HHS can work with city, county and state public health officials to provide resources to help reduce crisis points and save lives,” said Assistant Secretary for Health Admiral Brett P. Giroir, MD. “The donation of this data is critical for reducing the occurrence of the substance use epidemic and reaching the people who need help most.”


Aviva Bodek 


Antibiotic resistance is one of the greatest threats to global health today. In the U.S. alone, more than 2.8 million antibiotic-resistant infections occur each year, and more than 35,000 people die as a result. This translates to a death every 15 minutes as a result of an antibiotic-resistant infection. Future projections suggest that by 2050, 10 million mortalities a year will result from antibiotic-resistant bacteria, leading to a 2 to 3.5% reduction in Gross Domestic Product and costing the world up to $100 trillion.

Antibiotic resistance occurs naturally, but overuse of antibiotics is drastically accelerating the process. Reducing the profligate use of antibiotics is a crucial element in preventing further bacterial resistance from emerging.
 

Reducing Antibiotic Use in the Hospital

Hospital antibiotic stewardship programs (ASPs) can reduce inappropriate antibiotic use and are now a mandatory entity in all U.S. hospitals. The new rule from the Centers for Medicare & Medicaid Services (CMS) dictates that all hospitals will be required to have infection prevention and control and stewardship programs in place by March 30, 2020 in order to receive payments from the agency. Hospital accrediting bodies such as The Joint Commission have required antibiotic stewardship programs in hospitals since 2017.
 
An ASP is designed to provide guidance for the safe and cost-effective use of antibiotic agents. This evidence-based approach addresses the correct selection of antibiotic agents, dosages, routes of administration and duration of therapy. Such programs not only decrease antibiotic resistance, adverse drug events and hospital length of stay, but they can also save money for healthcare institutions. A University of Maryland study, for example, showed $3 million in cost savings in the first three years of an ASP.

According to the CDC, 20 to 50% of antibiotic use is unnecessary and inappropriate. While preventing infections is the first defense against antibiotic resistance, perhaps the single most important action needed to greatly slow down the development and spread of antibiotic-resistant infections is to change the way antibiotics are prescribed.

Examples of interventions to prevent overuse or overprescribing of antibiotics in hospitals include:

  • Use of rapid diagnostic testing
  • Restricting broad-spectrum antibiotics
  • Shortening the duration of therapy through automatic stop orders
  • Basing treatment on patient pharmacokinetic and pharmacodynamic characteristics
  • Developing institution-specific treatment guidelines
  • Therapeutic review with comprehensive feedback and provider education.


Leveraging Technology to Optimize Antibiotic Therapy

With so many components to a successful ASP, technology, such as clinical decision support systems (CDSSs) is critical to maximize program efficiency and effectiveness. Based on a sophisticated set of customizable rule engines, CDSSs can provide prompts and reminders to assist healthcare providers in implementing evidence-based clinical guidelines at the point of care.

CDSSs operate by continuously monitoring patient data to alert clinicians in real time of potential infections, drug-bug mismatches, multidrug-resistant organisms, isolation candidates, test results and reportable infections. These alerts help to identify patients for potential interventions. Several studies have demonstrated that CDSS implementation increases the number of antibiotic interventions that can be made by as much as 87%.  A significant time reduction in both de-escalation and escalation to appropriate antibiotic therapy has also been demonstrated.

Customization of the electronic health record (EHR) is another electronic tool that can bolster an ASP program. EHR capabilities may include tracking interventions, dose checking alerts, best practice guided order sets, antibiotic time-outs, antibiotic restriction processes, intravenous to oral conversion monitoring and tracking antibiotic prescribing practices.
 

Reporting on Facility and State Improvements

Technology can also be a major asset for the electronic reporting of antibiotic use and antibiotic resistance data to the Centers for Disease Control and Prevention’s National Healthcare Safety Network (NHSN). Although currently voluntary, NHSN antibiotic use and/or antibiotic resistance reporting has been identified as one option for eligible hospitals to meet Public Health Registry reporting criteria under Stage 3 of the CMS Meaningful Use (MU3) Program. The information must be submitted electronically in Health Level Clinical Document Architecture format. Manual data entry is not available for the Antibiotic Use and Resistance Module.

Collecting, analyzing and reporting data on antibiotic use and then using that information to improve prescribing practices is the foundation of a successful ASP leading to decreased antibiotic resistance. Technology such as CDSSs and EHR customization not only enables program metric tracking and reporting, it allows an ASP to reach a larger patient population and optimize resource utilization.