Outpatient Antibiotic Stewardship Initiative Open Office Hours Matt Lincoln, MBA, Director, Administrative Operations, Health Services Advisory Group (HSAG) Mary Fermazin, MD, MPA, Chief Medical Officer, Vice President, Health Policy and Quality Measurement, HSAG Thursday, October 5, 2017
Objectives At the conclusion of this webinar, attendees will be able to: Identify common barriers to implementing the Centers for Disease Control and Prevention (CDC) Core Elements of Outpatient Antibiotic Stewardship (AS). Apply best practices recommended during the webinar. Request additional individualized technical assistance offered by HSAG staff members, peers, or other subject-matter experts.
What is a Quality Innovation Network - Quality Improvement Organization (QIN-QIO)? Funded by the Centers for Medicare & Medicaid Services (CMS) Dedicated to improving health quality at the community level Ensures people with Medicare and Medicaid get the care they deserve Improves care for everyone Largest federal program dedicated to improving health quality at the community level Department of Health & Human Services CMS 3
HSAG s QIN-QIO Territory Nearly 25 percent of the nation s Medicare beneficiaries HSAG is the Medicare QIN-QIO for Arizona, California, Florida, Ohio, and the U.S. Virgin Islands. 4 Quality Innovation Network-Quality Improvement Organization (QIN-QIO)
Antibiotic Utilization Top Five Counties in California 55 percent of Part D antibiotic utilization 5 Source: C.3.10 NCC analysis of Part D claims data, NDC antibiotic drug codes, CY2016
Distribution of Recruited Outpatient Settings (297) by County Top Five Counties in California 6
AS is the Effort to Improve prescribing by clinicians and use by patients so that antibiotics are only prescribed and used when needed. Minimize misdiagnoses or delayed diagnoses leading to underuse of antibiotics. Ensure that the right drug, dose, and duration are selected when an antibiotic is needed. Measure antibiotic prescribing. The goal of AS is to maximize the benefit of treatment while minimizing harm to individuals and communities. 7 Sources: 1. CDC. MMWR, vol.65. No. 6, Nov. 11, 2016. https://www.cdc.gov/mmwr/volumes/65/rr/pdfs/rr6506.pdf. 2. CDC. Antibiotic resistance threats in the United States, 2013 [Internet]. Atlanta, GA: US Department of Health and Human Services, CDC; 2013. 3. Barlam TF, Cosgrove SE, Abbo LM, et al. Implementing an Antibiotic Stewardship Program: Guidelines by the Infectious Diseases Society of America and the Society for Healthcare Epidemiology of America. Clin Infect Dis 2016;62:e51 77
Project Timeline Recruitment Baseline Self-Assessment Kickoff Webinar Monthly Office Hours Quarterly Check-in Bite-Size Webinars 2016 2017 2018 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Today 8
Suggested Project Timeline * Commitment September 2017 Action for Policy and Practice November 2017 Tracking and Reporting March 2018 Education and Expertise May 2018 9 * Timeline is not evidence-based and is provided for discussion purposes only.
CDC Core Elements of Outpatient AS (November 2016) Provides a framework for AS for outpatient clinicians and facilities that routinely provide antibiotic treatment Augments existing guidance for other clinical settings: Core Elements of Hospital AS Programs (2014) Core Elements of AS for Nursing Homes (2015) 10 Source: CDC. MMWR, vol.65. No. 6, Nov. 11, 2016. https://www.cdc.gov/mmwr/volumes/65/rr/pdfs/rr6506.pdf.
Core Elements of Outpatient Antibiotic Stewardship Commitment: Demonstrate dedication to and accountability for optimizing antibiotic prescribing and patient safety. Action for policy and practice: Implement at least one policy or practice to improve antibiotic prescribing, assess whether it is working, and modify as needed. Tracking and reporting: Monitor antibiotic prescribing practices and offer regular feedback to clinicians or have clinicians asses their own antibiotic use. Education and expertise: Provide educational resources to clinicians and patients on antibiotic prescribing and ensure access to needed expertise on antibiotic prescribing. 11
Poll Question #1 Which CDC Core Element of Outpatient AS would you like to focus on today? A. Commitment B. Action C. Tracking and Reporting D. Education and Expertise
Core Element #1 Commitment
Core Element #2 Action
Viral Prescription Pads 16 Source: CDC. https://www.cdc.gov/getsmart/community/materials-references/print-materials/hcp/viral-rx-pad-color.pdf.
Core Element #3 Tracking and Reporting
Core Element #4 Education and Expertise
Bite-Size Webinars Practical strategies to improve infection prevention and AS Common barriers that lead to deviation from best practices Identifying high-priority conditions for intervention Using clinical practice guidelines to establish expectations for appropriate prescribing Strategies to improve provider patient communication 19
Patient Education Resources 20 Sources: English: http://consumerhealthchoices.org/wp-content/uploads/2015/02/3antibioticstri-fold_downloadgenericfinal.pdf Spanish: http://consumerhealthchoices.org/wp-content/uploads/2015/02/3antibioticstri-fold_downloadgenericspanish_final.pdf
Waiting Room Video Now Available! 21 https://www.youtube.com/playlist?list=plfm1t1zovvimvxtmucx0z-pbwb8qe1ap9
MIPS Overview
What Will Determine My MIPS* Score? The MIPS composite performance score will factor in four weighted categories: Quality Cost Improvement activities Advancing care Information 60% 0% 15% 25% MIPS Composite Performance Score 23 *Merit-Based Incentive Payments System (MIPS) Source: The Centers for Medicare & Medicaid Services
MIPS AS Quality Measures Examples of MIPS Quality Measures that align with the Outpatient AS Initiative: Quality ID 331 Adult Sinusitis: Antibiotic Prescribed for Acute Sinusitis (Overuse) Quality ID 332 Adult Sinusitis: Appropriate choice of Antibiotic: Amoxicillin, with or without Clavulanate prescribed for patients with Acute Bacterial Sinusitis (Appropriate Use) NQF* 0058 Avoidance of Antibiotic Treatment in Adults with Acute Bronchitis 24 *National Quality Forum (NQF)
MIPS AS Improvement Activity Example of MIPS Improvement Activity that aligns with the Outpatient AS Initiative: Implementation of AS Program (Weight: Medium) Implementation of an AS program that measures the appropriate use of antibiotics for several different conditions (URI* Rx** in children, diagnosis of pharyngitis, Bronchitis Rx in adults) according to clinical guidelines for diagnostics and therapeutics. 25 *Upper Respiratory Infection (URI) **Medical Prescription (Rx)
HSAG QPP Service Center: Tools and Resources This is the Tools and Resources page 26 HSAG QPP Website: www.hsag.com/qpp
Next Steps Complete baseline self-assessment by October 12. Attend monthly office-hours coaching calls every first Thursday at 12 Noon (PT) beginning October 5, 2017. Review recorded Bite-Size webinars beginning in December 2017. Schedule first quarterly check-in call with HSAG specialist before October 31, 2017. Contact HSAG at any time to be connected with AS subject-matter experts for coaching or troubleshooting. 27
Poll Question #2 Which CDC Core Element of Outpatient AS would you like to focus on during the next Open Office Hours Webinar? A. Commitment B. Action C. Tracking and Reporting D. Education and Expertise
Thank you! Matt Lincoln, MBA Director, Administrative Operations, Health Services Advisory Group (HSAG) mlincoln@hsag.com Keith Chartier, MPH Associate Director, Nursing Homes, HSAG kchartier@hsag.com Mary Fermazin, MD, MPA Chief Medical Officer, Vice President, Health Policy and Quality Measurement, HSAG mfermazin@hsag.com Eli DeLille, BSN, RN, CIC Quality Improvement Specialist, HSAG edelille@hsag.com Joseph De Veyra, DNP, RN, PHN, PCCN, CNL Executive Director, HSAG jdeveyra@hsag.com
This material was prepared by Health Services Advisory Group, the Medicare Quality Improvement Organization for California, under contract with the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services. The contents presented do not necessarily reflect CMS policy. Publication No. CA-11SOW-C.3.10-09222017-02.