In the pay-for-performance environment in which hospitals now operate, meeting specific outcome goals and quality metrics directly affects hospital reimbursements. The Centers for Medicare and Medicaid (CMS) has led this movement through its value-based purchasing program by rewarding improved clinical outcomes with incentive payments for reducing the incidence of central line-associated bloodstream infections (CLABSIs), catheter-associated urinary tract infections (CAUTIs), surgical site infections (SSIs), and C. difficile infection (CDI).
Quality and accreditation programs are expanding to include antimicrobial stewardship measures. The White House published a National Strategy for Combating Antibiotic-Resistant Bacteria in March 2015, establishing a five-year plan that mandates antimicrobial stewardship programs for all hospitals, long-term care facilities and nursing homes as part of the standard Medicare Conditions of Participation.1 The Plan also recommends including reporting on antimicrobial use and resistance in the CMS Inpatient Quality Reporting Program by 2020. The Joint Commission has also proposed a new standard for antimicrobial resistance programs (ASPs).2
Tracking these new metrics, including monitoring organizational performance improvement efforts that target them, requires integration of patient data from information sources across the hospital. Documenting progress for hospital administrators, commercial payers, and the National Health Safety Network (NHSN) demands sophisticated reporting capabilities.
Clinical decision support systems provide critical assistance in achieving compliance with VBP and other quality measures throughout the hospital. They can identify emerging healthcare-associated infections, recommend appropriate antimicrobials and dosages, alert clinicians to potential adverse drug events, and flag readmitted patients who have previously had C. difficile infections.
A web-based, real-time clinical surveillance and decision support system (CDSS), such as Sentri7, enables clinicians to focus on improving care instead of compiling data and assembling reports. It can stratify risk so that clinicians can focus on the most urgent issues and act to capture opportunities for most significant improvement. At the same time, it can support clinicians by working within established workflows, integrating easily updated clinical rules, offering information at the point of care, and presenting data in intuitive dashboards.
CDSS enable infection preventionists, pharmacists, quality teams, clinicians, and administrators to work together to prevent hospital-associated conditions, reduce the risk of C. difficile infections, slow the emergence of multidrug resistant organisms, shorten hospital stays, reduce readmission rates, lower pharmacy costs, and maximize reimbursements. By enhancing care, improving outcomes and simplifying reporting, they help hospitals achieve the goals of value-based purchasing programs, for the ultimate benefit of patients, payers and healthcare organizations.
- National Strategy for Combating Antibiotic-Resistant Bacteria. September 2014. Accessed January 12, 2016: https://www.whitehouse.gov/sites/default/files/docs/carb_national_strategy.pdf
- The Joint Commission Proposed New Standard on Antimicrobial Stewardship. Accessed January 12, 2016: http://www.jointcommission.org/joint_commission_joins_white_house_effort_to_reduce_antibiotic_overuse/