Effects of pay-for-performance based antimicrobial stewardship on antimicrobial consumption and expenditure: An interrupted time series analysis

Haohai Xia; Jia Li; Xinyi Yang; Yingchao Zeng; Lin Shi; Weibin Li; Xu Liu; Shifang Yang; Manzhi Zhao; Jie Chen; Lianping Yang

doi:10.1016/j.heliyon.2024.e32750

Effects of pay-for-performance based antimicrobial stewardship on antimicrobial consumption and expenditure: An interrupted time series analysis

Heliyon. 2024 Jun 8;10(12):e32750. doi: 10.1016/j.heliyon.2024.e32750. eCollection 2024 Jun 30.

Authors

Haohai Xia¹, Jia Li², Xinyi Yang¹, Yingchao Zeng¹, Lin Shi¹, Weibin Li¹, Xu Liu³, Shifang Yang⁴, Manzhi Zhao⁴, Jie Chen², Lianping Yang¹

Affiliations

¹ School of Public Health, Sun Yat-sen University, Guangzhou, China.
² Department of Pharmacy, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.
³ Department of Infectious Disease, The Fifth Affiliated Hospital, Sun Yat-sen University, Zhuhai, China.
⁴ Department of Pulmonary and Critical Care Medicine, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, Guangzhou, China.

Abstract

Objectives: To evaluate the impact of pay-for-performance on antimicrobial consumption and antimicrobial expenditure in a large teaching hospital in Guangzhou, China.

Methods: We collected data from hospital information system from January 2018 through September 2022 in the inpatient wards. Antimicrobial consumption was evaluated using antibiotic use density (AUD) and antibiotic use rate (AUR). The economic impact of intervention was assessed by antimicrobial expenditure percentage. The data was analyzed using interrupted time series (ITS) analysis.

Results: Following the implementation of the intervention, immediate decreases in the level of AUD were observed in Department of Hematology Unit 3 (β = -66.93 DDDs/100PD, P = 0.002), Urology (β = -32.80 DDDs/100PD, P < 0.001), Gastrointestinal Surgery Unit 3 (β = -11.44 DDDs/100PD, P = 0.03), Cardiac Surgery (β = -14.30 DDDs/100PD, P = 0.01), ICU, Unit 2 (β = -81.91 DDDs/100PD, P = 0.02) and Cardiothoracic Surgery ICU (β = -41.52 DDDs/100PD, P = 0.05). Long-term downward trends in AUD were also identified in Organ Transplant Unit (β = -1.64 DDDs/100PD, P = 0.02). However, only Urology (β = -6.56 DDDs/100PD, P = 0.02) and Gastrointestinal Surgery Unit 3 (β = -8.50 %, P = 0.01) showed an immediate decrease in AUR, and long-term downward trends in AUR were observed in Pediatric ICU (β = -1.88 %, P = 0.05) and ICU Unit 1 (β = -0.55 %, P = 0.02).

Conclusion: This study demonstrates that the adoption of pay-for-performance effectively reduces antibiotic consumption in specific departments of a hospital in Guangzhou in the short term. However, it is important to recognize that the long-term impact of such interventions is often limited. Additionally, it should be noted that the overall effectiveness of the intervention across the entire hospital was not significant.

Keywords: Antimicrobial consumption; Antimicrobial stewardship; Interrupted time series analysis; One-off bonus payment; Penalty.