• Kalvin Yu, Jay Rho, Marlene Morcos, Jim Nomura, Donald Kaplan, Keith Sakamoto, Doan Bui, Sandy Yoo, and Jason Jones.
• Kalvin Yu, M.D., is Regional Chief of Infectious Diseases, Southern California Permanente Medical Group, Kaiser Permanente (KP) West Los Angeles Medical Center, Los Angeles, CA. Jay Rho, Pharm.D., is Senior Director, K P, Pasadena, CA. Marlene Morcos, Pharm.D., is Inpatient Pharmacy Supervisor; and Jim Nomura, M.D., is Chief of Infectious Diseases, KP Los Angeles Medical Center, Los Angeles, CA. Donald Kaplan, Pharm.D., is Inpatient Pharmacy Practice Coordinator, Southern California Region, KP National Pharmacy Programs and Services, Downey, CA. Keith Sakamoto, Pharm.D., is Inpatient Pharmacy Specialist, KP West Los Angeles Medical Center. Doan Bui, Pharm.D., is Inpatient Pharmacy Specialist; and Sandy Yoo, Pharm.D., is Inpatient Pharmacy Specialist, KP Los Angeles Medical Center. Jason Jones, Ph.D., is Executive Director, Clinical Intelligence and Decision Support, KP, Pasadena, CA. kalvin.c.yu@kp.org.
• Am J Health Syst Pharm. 2014 Jun 15; 71 (12): 1019-28.

PurposePatient care improvements and cost savings achieved by a large integrated health system through the implementation of antimicrobial stewardship programs (ASPs) at two hospitals are reported.MethodsA pre-post analysis was conducted to evaluate cost and quality outcomes at the two ASP sites and three similar sites within the same health system not included in the ASP initiative. The utilization of 15 targeted antimicrobials and associated costs at the five sites during designated preimplementation and postimplementation periods were compared; changes in Hospital Standardized Mortality Ratio (HSMR) values for specific infections among Medicare patients were also assessed.ResultsIn the year after ASP implementation, aggregate direct antimicrobial acquisition costs at the two study sites decreased 17.3% from prior-year levels and increased by 9.1% at the three comparator sites. Significant decreases in the consumption of targeted antimicrobial classes (antipseudomonals, quinolones, and agents active against methicillin-resistant Staphylococcus aureus) were observed at the ASP sites. Among the 2446 ASP interventions recorded, 72% involved discontinuing or narrowing the use of broad-spectrum antimicrobials. Although rates of health care-associated Clostridium difficile infection were little changed at both study sites after ASP implementation, HSMR data indicated substantial gains in combating sepsis and C. difficile and respiratory infections.ConclusionAfter implementation of ASPs at two study sites, the utilization of all classes of antibiotics decreased and antimicrobial costs per 1000 patient-days decreased. While HSMR values for sepsis (including C. difficile-associated cases) and respiratory infections improved, the rate of C. difficile infections stayed the same.Copyright © 2014 by the American Society of Health-System Pharmacists, Inc. All rights reserved.

22 keywords...

hide…