Managing Antibiotics

As an adjunct to the C. difficile Collaborative, the Fund and Greater New York Hospital Association (GNYHA) are managing two projects for health care facilities to implement programs that guide the appropriate use (and prevent overuse) of antibiotics. Studies suggest that such stewardship programs can improve clinical outcomes and may reduce C. difficile infections, which can be deadly and present a range of major concerns for health care providers and patients alike.

In the first project, which was funded by the New York State Department of Health and has just concluded, three hospitals participating in the C. difficile Collaborative partnered with three long-term care facilities and collaboratively tested programs to manage antibiotic use. The partnering between acute and long-term care facilities was a key aspect of the project because transitions between health care facilities present special challenges.  Partners included Lutheran Medical Center and Lutheran Augustana Center for Extended Care and Rehabilitation, North Shore University Hospital and the Stern Family Center for Extended Care and Rehabilitation, and St. Catherine's of Siena Medical Center and St. Catherine of Siena Nursing Home.  The partnering facilities formed interdisciplinary teams responsible for implementing a range of practices, such as developing guidelines for diagnosis, treatment, and duration of antibiotic therapy to treat infections; identifying dose-optimization strategies; and determining the optimal list of antibiotics to include in each hospital's formulary.  The project participants also developed an extensive tool kit, which will soon be accessible on the Fund's website as well as GNYHA's website. 

In the second, and complementary, project, the Fund and GNYHA are collaborating with Montefiore Medical Center (whose participation is funded by a grant from the Agency for Healthcare Research and Quality) to determine the effectiveness of different antibiotic management strategies in reducing C. difficile infections. A group of ten hospitals is being split into intervention and control groups. The intervention group is implementing select stewardship practices, which may involve specific antibiotics or classes of antibiotics. Rates of C. difficile infection and antibiotic use are being measured before, during, and after the interventions. All ten hospitals are also participants in the C. difficile Collaborative, and they will continue to assess infection rates and take part in the development of tools and best practice guidelines for use by other organizations. The project will also analyze costs and conduct other associated evaluations.

The Fund and GNYHA expect that these pilot projects will expand to include a larger regional group of health care institutions in a concerted effort to ensure the appropriate use of antibiotics.

Project Contact: Hillary Jalon