Outpatient health facilities are critical battlegrounds in the fight against antibiotic-resistant infections that sicken nearly 3 million Americans and kill 35,000 each year. From doctor’s offices to urgent care centers, these outpatient settings account for about 60% of all U.S. antibiotic-related expenditures.
However, about one-third of outpatient antibiotic prescriptions are unnecessary. Fortunately, no-cost software tools are available to help health care systems preserve the efficacy of antibiotics by prescribing them only when they’re needed.
Each time an antibiotic is used, pathogens have the opportunity to “learn” to evade the drugs designed to conquer them, contributing to the emergence of drug-resistant bacteria that make infections deadlier and more difficult and costly to treat. That’s one reason why these medications must be prescribed only when necessary and appropriate for people with bacterial infections. In addition, overprescribing antibiotics for patients with common outpatient infections is expensive, resulting in millions of dollars in increased annual health care costs. And inappropriate prescribing of antibiotics can lead to alarming adverse patient outcomes, including C difficile, a stubborn, sometimes life-threatening infection related to antibiotic use.
Antibiotic stewardship programs promote responsible antibiotic use, including ensuring that the right drug is prescribed in the right dose at the right time. These programs are underutilized in outpatient settings, but, when used strategically and effectively, they can improve the quality of care patients receive by providing clinicians with data on their prescribing practices. Indeed, “tracking and reporting” are fundamental components of the Centers for Disease Control and Prevention’s Core Elements of Outpatient Antibiotic Stewardship. Making clinicians aware that they prescribe more frequently than their peers has been shown to result in doctors prescribing these drugs more judiciously.
And although it can be challenging to promote antibiotic stewardship among the diffuse outpatient facilities, health systems are well-positioned to support this expansion of stewardship efforts. One study estimated that about half of all primary care physicians were affiliated with a health system in 2021, giving health system-led antibiotic stewardship efforts the potential to affect a vast number of outpatient facilities in the U.S.
A recent commentary in the Joint Commission Journal on Quality and Patient Safety discussed specific approaches health systems can take to support outpatient stewardship, including standardizing stewardship practices throughout their facilities and leveraging their centralized resources and infrastructure to help minimize duplication of efforts. One way health systems can support outpatient stewardship by using shared electronic health record (EHR) systems to inform providers—through direct feedback—about how their antibiotic prescribing compares to their peers.
However, developing these feedback mechanisms—even at the health system level—can be time-consuming. That’s where open-source tools such as OASIS (Outpatient Automated Stewardship Information System) come in. Launched by Denver Health in the spring of 2023, OASIS is a first-of-its-kind tool that aims to support antibiotic stewardship efforts in health systems throughout the country by harnessing data from electronic health recordsto evaluate antibiotic prescribing. This tool, created with support from The Pew Charitable Trusts, is free to use and requires no modifications to the EHR. Additionally, anyone with access to R, a free statistical software, and an EHR data warehouse can begin to use OASIS.
OASIS addresses some of the long-standing barriers health systems have experienced in their stewardship efforts by streamlining the lengthy data analytic process. OASIS simplifies this process, which is necessary to effectively track and report antibiotic use by automatically pulling key data on how antibiotics are being used for specific diagnoses. The tool then creates antibiotic prescribing reports and directly emails the findings to clinicians, who can then more effectively evaluate their prescribing practices and ensure the appropriate use of these critical drugs.
Simple, affordable, effective interventions such as OASIS can make outpatient antibiotic stewardship an easy yes for health systems looking to expand their stewardship efforts. By using tools such as OASIS to harness antibiotic prescribing data, health systems can scale stewardship programs to their outpatient facilities and help slow the emergence of deadly superbugs that cost our nation billions of dollars and tens of thousands of lives each year.
Contagion interviewed a clinician on how she is using Oasis at her institution.
