One Intermountain and Antibiotic Stewardship – SCORE UC

February 2020ECHO - EASIE

Eddie Stenehjem, MD MScMedical Director of Antibiotic Stewardship Office of Patient Experience

Disclosures

I receive funding from CDC and AHRQ for antibiotic stewardship implementation research.

I am part of an advisory panel for Becton Dickson (BD) providing content expertise on diagnostic stewardship.

Objectives

1. Describe why Urgent Care Stewardship is needed.

2. Describe how and why the urgent care antimicrobial stewardship campaign has been successful.

Antibiotic Stewardship at Intermountain Healthcare

Large Hospital/TraumaCenterHospital

InpatientRehab

Skilled NursingFacility

OutpatientRehab

HomeHealth

SpecialtyClinic

Urgent CareClinic

TeleHealth

Home

Retail Pharmacy

PrimaryCare Clinic

Safest, highest quality, most affordable care for serious injury and illness

COMMUNITY-BASED CARE SPECIALTY-BASED CARE

>50% of outpatient antibiotics

Background:

• Rapidly growing sector of outpatient care delivery

• Inappropriate antibiotic prescribing may be higher than other settings

0

2000

4000

6000

8000

10000

2014 2015 2016 2017 2018 2019

Urgent Care Centers in the US

Palms, et al. JAMA Intern Med. 2018 Sep 1; 178(9)

45.7%

24.6%17% 14.4%

Intermountain’s Respiratory Antibiotic Prescribing Rate

Stenehjem E, Wallin A, Fleming-Dutra, KE, et al. Clinical Infectious Diseases. 2019.

SCORE UC Objective

Improve respiratory antibiotic prescribing in our urgent care network by implementing a comprehensive outpatient stewardship program.

Primary Target:

• Respiratory prescribing

Funded by CDC SHEPheRD Contract.

Stewardship in Community Outpatient settings - Resources and Engagement - Urgent Care

SCORE-UC Interventions

• Education – Clinicians• Education – Patients• iCentra tools• Transparent Data• Media

*All based on patient/provider interviews and observations done before the intervention

Interventions: Clinician Education

• CPMs updated

• Regional UC monthly meetings

• Blog posts/Podcasts

• Site visits

• Clinic materials

9

Interventions: Patient Education -https://printit.intermountain.net/

10

Interventions: iCentra

• Delayed Prescriptionso “Amox only”

• Quick Visits

• Azithromycin Alert

11

Intervention: Accessible data with peer comparison

Accessible:

1. Shortcut in iCentra

2. https://intermountainhealthcare.org/antibiotics

3. Intermountain.net: “abx” → tracking and reporting → Urgent Care Outpatient Provider Report

4. Save link as a favorite in browser

12

Respiratory Prescribing Metrics

Primary Measure:

1. Respiratory encounter prescribing rate

Secondary measures:

2. Delayed prescribing use for sinusitis/OM/pharyngitis

3. First line therapy use for sinusitis/OM/pharyngitis

4. Respiratory “Tier 3” antibiotic prescribing rate

Respiratory encounter antibiotic prescribing rate

Definition: Respiratory encounter with antibiotic prescribed Total Respiratory encounters

Respiratory Encounter: An encounter with a billed respiratory ICD10 code

Why we use this: • Agnostic of coding practices• Large number of encounters – common encounter type • Significant variation is present

Intervention: Media

• Commitment Posters

• Clinic messaging

• Traditional & social media

• Raising awareness and changing patient perceptions before they see the clinician

21

Intervention: Media

Collaborative Effort with Focus

• CBC/Urgent Care Leadership• OPE/AS team• CTIS• Healthcare Delivery Institute• Office of Research• Continuous Improvement• Media and PPP Team• Pharmacy

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Virtual Care

People in Our Communities

InpatientOutpatient Executive Leadership Team

STRATEGY

ACOO | ACNO | ACMOACOO | ACNO | ACMO

Clinical Programs

Research & Academics

Shared Support Services

SelectHealth | Aligned Payers

ACOO

Intermountain Foundation

Medical Group | Affiliated Network

Shared Clinical Services

50% → 33%17,000 Abx scripts avoided120,000 days of avoided

52%

47%

51% 51% 51%52%

49%

45%

49%

51%53%

51%

44%

40%38%

40%

37%37%

33%

20%

25%

30%

35%

40%

45%

50%

55%

Jul-18 Aug-18 Sep-18 Oct-18 Nov-18 Dec-18 Jan-19 Feb-19 Mar-19 Apr-19 May-19 Jun-19 Jul-19 Aug-19 Sep-19 Oct-19 Nov-19 Dec-19 Jan-20

Intervention Starts• Data• Media• EHR Tools• Education

Respiratory prescribing rate – Urgent Care

What’s next for antibiotic stewardship?

• Continue support urgent care efforts

• New antibiotic prescribing culture and standard

• Support FM/IM/Peds in their stewardship goals

• Work with SelectHealth in targeting affiliated clinics

• Developing a Utah community of antibiotic stewards

Questions?

Eddie Stenehjem, MD MSc

Medical Director, Antibiotic Stewardship

Intermountain Healthcare

Salt Lake City, UT

eddie.Stenehjem@imail.org

@E_Stenehjem