Health Data Tool Helps Remove Barriers to Effective Antibiotic Stewardship

Research shows that about one-third of outpatient antibiotic prescriptions are unnecessary, but the Outpatient Automated Stewardship Information System (OASIS), a tool launched by a team in Colorado in 2023, is helping to break down barriers to more appropriate use of these critical drugs. That’s according to a new study from Denver Health, a Colorado-based health care organization that serves much of the state.

The study evaluated the implementation of this first-of-its-kind free resource across 11 clinics and 195 clinicians at Denver Health and Hospital Authority and Children’s Hospital Colorado from July 2022 through June 2023. OASIS proved to be an efficient tool for stewardship leaders to monitor, provide feedback on, and improve antimicrobial prescribing practices within their clinics.

Tracking and reporting antibiotic use is a core element of high-quality stewardship efforts. Successful initiatives to reduce inappropriate prescribing can help to minimize the development of antibiotic-resistant bacteria and ensure the continued effectiveness of these medications. Such programs, however, have historically been difficult to implement in outpatient settings—especially smaller health systems and practices—because of the time and resources required. But this study found that after an initial setup time for OASIS, ranging from one to six hours, the time spent to send reports was only 10 minutes per month.

Created with support from The Pew Charitable Trusts, OASIS streamlines and simplifies the data analytic process required for antibiotic stewardship efforts by automatically pulling antibiotic use data from electronic health records and other health care data systems. The tool then creates reports that are sent directly to clinicians to help them understand how their prescribing practices relate to those of their peers, an approach that has proven to drive more appropriate antibiotic use.

Quick and reliable access to these automated feedback reports allows clinicians to more effectively evaluate their own prescribing practices. The study showed that providing clinicians with ongoing access to this information led to a significant reduction in unnecessary antibiotic prescriptions for respiratory conditions at Children’s Hospital Colorado. For example, the participating clinics reported a 22% increase in the use of a five-day course of antibiotics for acute middle ear infections, rather than a longer duration of treatment that unnecessarily increases the risk of antibiotic resistance and side effects to the drugs for patients.

Although a similar improvement was not seen at the Denver Health and Hospital Authority, the study’s authors think that is likely because the baseline use of five-day treatments was already relatively high within these clinics.

Overall, the study results suggest that OASIS was able to improve prescribing within the health systems that were evaluated, without requiring significant staff time and resources. The findings should encourage other outpatient stewardship leaders to put this tool to use as an effective and efficient way to strengthen stewardship efforts, improve patient outcomes, and slow the emergence of dangerous, drug-resistant bacteria.

David Hyun, M.D., is project director and Rachel Zetts, M.P.H., is a senior officer with The Pew Charitable Trusts’ antibiotic resistance project.