Kelly L Fargo1, Jessica Johnston2, Kurt B Stevenson3, Meredith Deutscher4, Erica E Reed5. 1. Department of Pharmacy, Fairview Hospital, a Cleveland Clinic Hospital , Cleveland, Ohio. 2. Division of Infectious Diseases, College of Medicine, The Ohio State University Wexner Medical Center , Columbus, Ohio. 3. Division of Epidemiology, College of Public Health, The Ohio State University , Columbus, Ohio. 4. Infectious Diseases Department, Kaiser Permanente , Roseville, California. 5. Department of Pharmacy, The Ohio State University Wexner Medical Center , Columbus, Ohio .
Abstract
BACKGROUND: Studies evaluating the impact of passive cost visibility tools on antibiotic prescribing are lacking. OBJECTIVE: The objective of this study was to evaluate whether the implementation of a passive antibiotic cost visibility tool would impact antibiotic prescribing and decrease antibiotic spending. METHODS: An efficiency and effectiveness initiative (EEI) was implemented in October 2012. To support the EEI, an antibiotic cost visibility tool was created in June 2013 displaying the relative cost of antibiotics. Using an observational study of interrupted time series design, 3 time frames were studied: pre EEI, post EEI, and post cost visibility tool implementation. The primary outcome was antibiotic cost per 1,000 patient days. Secondary outcomes included case mix index (CMI)-adjusted antibiotic cost per 1,000 patient days and utilization of the cost visibility tool. RESULTS: Initiation of the EEI was associated with a $4,675 decrease in antibiotic cost per 1,000 patient days (P = .003), and costs continued to decrease in the months following EEI (P = .009). After implementation of the cost visibility tool, costs remained stable (P = .844). Despite CMI increasing over time, adjustment for CMI had no impact on the directionality or statistical significance of the results. CONCLUSION: Our study demonstrated a significant and sustained decrease in antibiotic cost per 1,000 patient days when focused medication cost reduction efforts were implemented, but passive cost visibility tool implementation was not associated with additional cost reduction. Antibiotic cost visibility tools may be of most benefit when prior medication cost reduction efforts are lacking or when an active intervention is incorporated.
BACKGROUND: Studies evaluating the impact of passive cost visibility tools on antibiotic prescribing are lacking. OBJECTIVE: The objective of this study was to evaluate whether the implementation of a passive antibiotic cost visibility tool would impact antibiotic prescribing and decrease antibiotic spending. METHODS: An efficiency and effectiveness initiative (EEI) was implemented in October 2012. To support the EEI, an antibiotic cost visibility tool was created in June 2013 displaying the relative cost of antibiotics. Using an observational study of interrupted time series design, 3 time frames were studied: pre EEI, post EEI, and post cost visibility tool implementation. The primary outcome was antibiotic cost per 1,000 patient days. Secondary outcomes included case mix index (CMI)-adjusted antibiotic cost per 1,000 patient days and utilization of the cost visibility tool. RESULTS: Initiation of the EEI was associated with a $4,675 decrease in antibiotic cost per 1,000 patient days (P = .003), and costs continued to decrease in the months following EEI (P = .009). After implementation of the cost visibility tool, costs remained stable (P = .844). Despite CMI increasing over time, adjustment for CMI had no impact on the directionality or statistical significance of the results. CONCLUSION: Our study demonstrated a significant and sustained decrease in antibiotic cost per 1,000 patient days when focused medication cost reduction efforts were implemented, but passive cost visibility tool implementation was not associated with additional cost reduction. Antibiotic cost visibility tools may be of most benefit when prior medication cost reduction efforts are lacking or when an active intervention is incorporated.
Authors: D W Bates; G J Kuperman; A Jha; J M Teich; E J Orav; N Ma'luf; A Onderdonk; R Pugatch; D Wybenga; J Winkelman; T A Brennan; A L Komaroff; M J Tanasijevic Journal: Arch Intern Med Date: 1997-11-24
Authors: Scott Fridkin; James Baggs; Ryan Fagan; Shelley Magill; Lori A Pollack; Paul Malpiedi; Rachel Slayton; Karim Khader; Michael A Rubin; Makoto Jones; Matthew H Samore; Ghinwa Dumyati; Elizabeth Dodds-Ashley; James Meek; Kimberly Yousey-Hindes; John Jernigan; Nadine Shehab; Rosa Herrera; Clifford L McDonald; Amy Schneider; Arjun Srinivasan Journal: MMWR Morb Mortal Wkly Rep Date: 2014-03-07 Impact factor: 17.586