National Healthcare Safety Network Antimicrobial Use Measure
This measure assesses antimicrobial use in hospitals based on medication administration data that hospitals collect electronically at the point of care and report via electronic file submissions to CDC’s National Healthcare Safety Network (NHSN). The antimicrobial use data that are in scope for this measure are antibacterial agents administered to adult and pediatric patients in a specified set of ward and intensive care unit locations: medical, medical/surgical, and surgical wards and units. The measure compares antimicrobial use that the hospitals report with antimicrobial use that is predicted on the basis of nationally aggregated data. The measure is comprised of a discrete set of ratios, Standardized Antimicrobial Administration Ratios (SAARs), each of which summarizes observed-to-predicted antibacterial use for one of 16 antibacterial agent-patient care location combinations. The SAARs are designed to serve as high value targets or high level indicators for antimicrobial stewardship programs (ASPs). SAAR values that are outliers are intended to prompt analysis of possible overuse, underuse, or inappropriate use of antimicrobials, subsequent actions aimed at improving the quality of antimicrobial prescribing, and impact evaluations of ASP interventions.
ACP does not support NQF measure #2720: “National Healthcare Safety Network Antimicrobial Use Measure.” This measure represents an important clinical concept; however, the specifications are flawed and the benefit of measuring antibiotic use on improvements in clinical outcomes is unclear. Developers note that the measure is not ready for accountability purposes in the NQF-submission materials. Furthermore, it is unclear why the risk-adjustment model includes facility-level characteristics. Poorly performing hospitals should aim to improve performance rates, regardless of medical school affiliation or ICU size. Instead, abstractors should stratify results by these characteristics to demonstrate meaningful differences in clinical outcomes across institutions. Also, it is unclear whether the benefits of measuring antibiotic days outweigh the potential harms. Measuring antibiotic use without regard to indication could promote premature discontinuation of antibiotic therapy or encourage clinicians to withhold treatment all together. Coupling this information to specific diagnosis related groups (DRGs) may be more beneficial. A stronger measure may target specific diagnoses for focused interventions to curb overuse.