Upload
pya
View
206
Download
1
Embed Size (px)
Citation preview
June 10, 2016
Presented by:
James M. Keegan, MD
ALABAMA HOSPITAL ASSOCIATION
The ROI of Avoiding Antibiotic
Overuse
Prepared for Alabama Hospital Association Page 14
Presented by James M. Keegan, MD
Native Kingsport, Tennessee
Emory University, Atlanta, Georgia
U.S. Air Force, Ellsworth AFB
South Dakota Commendation: Meritorious Service
Chief of Medical Staff
University of Vermont
Infectious Disease Fellowship
1986-1990 Clinical Practice of Infectious Disease
with Fred Kerns, MD, Charleston WV
1990-2005 Clinical Practice Infectious Disease
1990-Pres Medical Director of Infection Control,
Rapid City Regional Hospital and Regional Health
(Western SD)
2001-Pres Medical Director
Antibiotic Stewardship,
Rapid City Regional Hospital
2005-2013 Administrative Leadership
in Regional Health Vice President Quality Chief Medical Officer
Chief Executive Officer of Regional Health
Physicians 1 of 5 Senior Executive
Team Members
Prepared for Alabama Hospital Association Page 15
Success is walking from failure to failure with no loss of enthusiasm.
Prepared for Alabama Hospital Association Page 16
Winston Churchill
Prepared for Alabama Hospital Association Page 17
He who knows best knows how little he knows.
Prepared for Alabama Hospital Association Page 18
Thomas Jefferson
Prepared for Alabama Hospital Association Page 19
Leadership is about making others better as a result of your
presence and making sure that impact lasts in your absence.
Prepared for Alabama Hospital Association Page 20
Sheryl Sandberg
Prepared for Alabama Hospital Association Page 21
The Problem Antibiotic Resistance
The Global Health Crisis
Each year in the U.S. at least 2-million Americans will become infected with bacteria that are resistant to antibiotics, and at least 23,000 die each year as a direct result... CDC
By 2050, more people will die (worldwide) from antibiotic resistance than from cancer. BBC
Prepared for Alabama Hospital Association Page 22
The Problem Antibiotic Resistance
The Global Health Crisis
20-50% of all antibiotics prescribed in U.S.
acute care hospitals are either unnecessary or
inappropriate.
Similar to the findings in hospitals, studies have
shown that 4075% of antibiotics prescribed in
nursing homes may be unnecessary or
inappropriate.
We can either work to improve antibiotic use and prevent infections,
or watch as the clock turns back to a world where simple infections kill people.
Tom Frieden, CDC
Prepared for Alabama Hospital Association Page 23
Historical Prescribing Practices
90-95% of all sinus infections
are viral, yet
Prepared for Alabama Hospital Association Page 24
Empiric Prescribing and Risks
At community hospitals, ONE of THREE
patients with bloodstream infections given
inappropriate therapy. Duke University
: Treatment given without knowledge of cause or nature of
disorder and based on experience, rather than logic.
Simple Definition of EMPIRICAL
empirical adjective | em-pir-i-kuh-l
Prepared for Alabama Hospital Association Page 25
The Dilemma for Physicians
Patient Expectations Prescribed antibiotic validates
illness Antibiotic often considered a
cure all Patient satisfaction scores
Physicians prescribe how they
have been historically trained
Treating the patient vs. solving
world issues
Prepared for Alabama Hospital Association Page 26
Regulatory Environment
Infectious Diseases Society of America (IDSA)
& Society for Healthcare Epidemiology of
America (SHEA) recommend antibiotic
stewardship as a Condition of Participation
by December 2017 to Centers for Medicare &
Medicaid Services (CMS)
CMS Requirement Immanent?
IDSA and SHEA letter to CMS, March 4, 2014.
Prepared for Alabama Hospital Association Page 27
Message Going Mainstream Growing Public Awareness of the Problem
USA needs to take
immediate steps to fight
super bugs, experts say.
Prepared for Alabama Hospital Association Page 28
Broad Spectrum Antibiotics
Use by State
Use of Quinolones in 2012
Source: IMS Xponent
Prepared for Alabama Hospital Association Page 29
MRSA
Incidence by Region
Prepared for Alabama Hospital Association Page 30
There is a disconnect, why?
Changing clinical behavior is difficult
Limited Antibiotic Stewardship experience
Broadcasting the problem does not equate with solving
the problem
Pharmacy champions and
others may not be
comfortable with task of
changing physician
prescribing behavior
Prepared for Alabama Hospital Association Page 31
What We Are Seeing
RESULTS
OBSERVATIONS
30 Hospital Collaborative
Prepared for Alabama Hospital Association Page 32
CDC Core Elements
13 Centers for Disease Control and Prevention, CDC, Core Elements of Hospital Antibiotic Stewardship Programs.
13 Centers for Disease Control and Prevention, CDC, Core Elements of Hospital Antibiotic Stewardship Programs.
Leadership Commitment
Accountability
Need Drug Expertise
Active Oversight
Tracking
Reporting
Ongoing Education
Antibiotic Stewardship
Prepared for Alabama Hospital Association Page 33
Our Philosophy
PRIMUM NON NOCERE
Prepared for Alabama Hospital Association Page 34
The Role of Diagnostics
Picture of lab things vials, samples, lab tests
Rapid Diagnostics
Pay now or pay more later
Prescribing contingent
upon lab results
Prepared for Alabama Hospital Association Page 35
Clostridium difficile (C.difficile)
Thoughts about this HAI
CDC Hazard Level Rank: Urgent Threat Assessment Highest
level
DEADLY: Contracting C. diff drastically reduces your chance of
leaving the hospital alive. If two patients come into the hospital with
the same diagnosis, the one who gets C. difficile is four times more
likely to die.
EXPENSIVE: $10K per incidence (national average)
I know that today I had 3 rooms closed down for C.diff. Meaning the patients
had discharged and the rooms steri-misted. Still have to confirm they're clean
before reopening them to accept patients. Normally takes 72 hours, depending
on when environmental services get there to steri-mist it
Prepared for Alabama Hospital Association Page 36
Valley Hospital ASP Results
C. difficile and ABX Correlation
Prepared for Alabama Hospital Association Page 37
Hospital Engagement Sample Results
C. difficile and Antibiotics Correlation
Prepared for Alabama Hospital Association Page 38
Penicillin
Allergy
If you are hospitalized and declare a penicillin allergy,
your mortality risk doubles if you are prescribed an
alternative medication
Avoiding penicillin means using alternatives that are less
effective, more expensive or have greater side effects
Add length of stay increase
Dangers for those /Treatment risk for those who think
they are allergic
Prepared for Alabama Hospital Association Page 39
Antibiotic Stewardship Program
Direct and Attributable Financial Benefits
20-50% reduction in total antibiotic expense with emphasis on broad spectrum antibiotics. Clinical improvement to more precise prescribing practices.
Reduce expenses associated with antibiotic inventory and related costs of maintaining inventory
Decrease C. difficile cases - 10% mortality rate and $10K per incidence cost associated with this HAI (national average)
Prepared for Alabama Hospital Association Page 40
Antibiotic Stewardship Program
Indirect Financial Benefits
Savings and improved outcomes that influence Value-Based Reimbursements
Avoids Unnecessary Admissions
Decreases LOS (Length of Stay)
Decreases Readmissions
Reduces risk for HAI (Hospital-Acquired Infections)
Improves DRG Sufficiency
Prepared for Alabama Hospital Association Page 41
Antibiotic Stewardship Program
Related Benefits
Public Relations and Improved Perceptions
Better Patient Care
Mitigate Legal Risk
Prepare for impending CMS Conditions of Participation related to the adoption of ASPs
Prepared for Alabama Hospital Association Page 42
Antibiotic Stewardship equals
Triple Aim
1. Improves Patient
Care and Outcomes
2. Reduces costs
3. Improves Health of a
Community
and it is Simply the Right Thing to Do.
Prepared for Alabama Hospital Association Page 43
Antibiotic Stewardship Program
Selected Programs and Savings
Location/Type of
Facility
Number of
Beds
Cost
Savings/Reductions
AS Team Composition
Monroe, Louisiana
Community Hospital
120 $177,000/ 1 Year ID Specialist, Clinical
Pharmacist
Dallas, Texas LTAC
Hospital
60 $159,580/ 15 Months ID Specialist, Director of
Pharmacy
Dorchester,
Massachusetts
Community Teaching
Hospital
159 $200,000-250,000/ 1
Year
ID Specialist, ID-trained
Pharmacist
Baltimore, MD Large
tertiary care, teaching
medical center
800 $2,949,705/ 3 Years
ID Specialist, Clinical
Pharmacist
Winston-Salem, NC
Academic Medical
Center
880 $920,070 to $2,064,441
per year over 11 years
2 ID Specialists, 3 Clinical
Pharmacists
Prepared for Alabama Hospital Association Page 44
RCRH Results
Rapid City Regional Hospital 417 Licensed beds
Ernst & Young ~$1 million antibiotic per
year cost savings
Prepared for Alabama Hospital Association Page 45
PYA ASP Team
Our Services
24/7 Access and Support of Infectious Disease Physician and
Team
20+ Years of ASP Experience with Proven Results
Train and Empower Physician and Pharmacy Champions
Concurrent Monitoring of Prescribing Practices
Ongoing Review and Data Analysis to Ensure Continued
Success
Transparent Reporting and Outcomes
Safety Bundle Recommendations
Prepared for Alabama Hospital Association Page 46
Public Health Crisis
resistance to antibiotics has become
a major threat to public health World Health Organization
Prepared for Alabama Hospital Association Page 47
PYAs ASP TEAM
Multidisciplinary Expertise
Prepared for Alabama Hospital Association Page 48
The most important weapon in your arsenal will be your ability to
adapt.
Prepared for Alabama Hospital Association Page 49
Batman
PERSHING YOAKLEY & ASSOCIATES, P.C.
800.270.9629 | www.pyapc.com
James M. Keegan, MD
(605) 408-6513
mailto:[email protected]