Ascension is embarking on a comprehensive project to promote appropriate antibiotic use among children with acute respiratory infections, the leading cause of pediatric visits across the health system.
The Patient-Centered Outcomes Research Institute recently awarded the St. Louis-based system $2.5 million to enhance antimicrobial prescribing practices for pediatric patients through a project that will involve more than 4,000 clinicians. The initiative will take place over three years and spans more than 200 Ascension ambulatory care sites in eight states.
"The really unique thing about Ascension is our footprint and how many states we cover," Mohamad Fakih, MD, Ascension's chief quality officer who is leading the project, told Becker's. "I think what we're going to learn from this is how much we can move the needle on a very large scale — it's almost like a national initiative, not just a system initiative."
The goal of the multi-year project is to reduce antibiotic misuse, thereby improving patient outcomes, and develop a replicable model other health systems can use as a framework to promote appropriate prescribing practices.
While most respiratory tract infections are caused by viruses, many patients are still inappropriately prescribed antibiotics due to factors ranging from uncertain diagnoses to pressure clinicians face from patients. The CDC estimates that about one-third of antibiotic prescriptions in the U.S. are unnecessary. Antibiotic overuse is a major contributor to drug resistance, a global health threat responsible for nearly 3 million infections in the U.S. annually.
The project at Ascension will encourage clinicians to implement practices that prevent inappropriate antibiotic use, drawing from past research that found narrow-spectrum antibiotics are as effective as broad-spectrum antibiotics in treating children with acute respiratory tract infections and carry fewer side effects. Broad-spectrum antibiotics target a wide variety of bacteria and are often used when the cause of an infection is unknown, but they can foster drug-resistant bacteria that are tougher to treat.
Dr. Fakih acknowledged that there are regional variations in the treatment and management of pediatric patients with acute respiratory infections, with the antimicrobial stewardship initiative serving as a key opportunity to standardize prescribing practices across ambulatory care settings.
Leaders of the project are working with analytics and technology teams to build data dashboards that will support clinicians in making progress on the project's aims.
"We're going to have dashboards that are very actionable, so we'll know where the opportunities are to intervene," Dr. Fakih said. "When we talk about more than 200 sites, that's not a small number of sites to address. This is where analytics is extremely important."
Patient education and shared-decision making are also central components of the project to ensure patients understand the reasoning behind their care team's decisions.
"If we don't engage well, we're not going to be as effective in giving the right treatment to patients," Dr. Fakih said. "We can have one of two things happen: Either just give patients an antibiotic and let them go and they don't need it, or tell them 'you don't need an antibiotic,' but they're not satisfied. That's where shared decision making makes a huge difference."