Frequently Asked Questions - Ambulatory Care Practices

1. What are the benefits of participating?

Our antibiotic stewardship team will work closely with staff members of your practice to develop or enhance the approaches your practice takes to optimize antibiotic prescribing. Using evidence-based, scientific, practical implementation strategies, we can help members of your practice understand antibiotic prescribing, improve their knowledge of antibiotic use, and identify approaches to promote appropriate antibiotic prescribing.

By participating, your practice will—

• Reduce unnecessary antibiotic use and promote appropriate antibiotic use
• Enhance teamwork and communication around diagnosis and treatment of infections and antibiotic prescribing in your practice
• Improve patient safety and safety culture 
• Improve workflow, especially during the busy cold and flu season
• Maintain and improve patient and family satisfaction 

 Our team of physicians has expertise in primary care and antibiotic stewardship and will be readily accessible for coaching, technical assistance, and ongoing education.

2. Can I earn CME/MOC or other credit for participating?

There are a host of educational and certification-related benefits of participating.

• Full participation in this program will help you fulfill quality reporting goals for the Merit-based Incentive Payment System (MIPS), one of two tracks under the Medicare Access and CHIP Reauthorization Act (MACRA). Participating in the program will help you meet MIPS quality measures related to several different conditions such as adult sinusitis, acute bronchitis, chronic sinusitis, and acute otitis externa.
• Continuing Medical Education (CME) and Quality Improvement/Patient Safety and Performance Improvement.
• Maintenance of Certification (MOC) credits will be available through the American Board of Pediatrics, the American Board of Internal Medicine, and the American Board of Family Medicine.
• Continuing Education credits will also be available for nurse practitioners.
• Participation in the program can demonstrate compliance with the new Joint Commission Ambulatory Antimicrobial Stewardship Standard as many of the concepts are similar.
  
  

3. What is antibiotic stewardship?

Antibiotic stewardship refers to the coordinated efforts to improve the use of antibiotics by promoting the selection of the optimal antibiotic regimen, dose, duration of therapy, and route of administration, when antibiotics are needed. Successful stewardship of antibiotics leads to decreased harm related to antibiotics such as Clostridioides difficile infection and other adverse events like rashes, yeast infections, and antibiotic-associated diarrhea.

4. What does it cost our practice to participate in the program?

Participation in the program is free. Participating practices will not incur any fees to receive assistance as a part of this program and will not receive any payment for their participation.

5. What is the timeline of the program?

This program asks for a 1-year commitment. Orientation Webinars to introduce the program and train representatives from your site about antibiotic stewardship will begin in November 2019. The table below shows practice tasks and due dates.

6. What is required of our practice in order to participate in the program?

Each site will identify a stewardship team (e.g., physician and practice manager) to assist with overseeing work. Activities include:

• Participating in regular 20-minute Webinars. Participants will receive training via Webinars held once or twice per month.
• Determining and implementing approaches to improve antibiotic use. Using approaches discussed in the Webinars, stewardship teams will develop and implement strategies for a common approach for patients with common antibiotic-appropriate and antibiotic-inappropriate conditions and optimize antibiotic therapy. In addition, teams will participate in assessing issues with how antibiotics are prescribed in their practices and developing improvement plans.
• Collecting and reviewing data. Your clinicians are encouraged to work together to review antibiotic use data.
  
  

7. How much time does this program take?

We anticipate that participating clinical staff will likely need to spend a minimum of 2 hours per month on the Agency for Healthcare Research and Quality (AHRQ) Safety Program for Improving Antibiotic Use. Approximately 1 hour would be devoted to participating in Webinars. The other hour would be spent making the changes discussed in the Webinars, or calling into office hours. Some time will be necessary to collect, submit, and review data.

8. When is the deadline to enroll?

The deadline to enroll in the program is November 29, 2019.

9. Is a contract required to participate in the program?

No, a contract is not required to participate in the program. To apply for the program, your practice manager or other primary contact will need to complete the online application form available at https://safetyprogram4antibioticstewardship.org.

The program requests a letter of commitment signed by an administrator and medical director or other physician champion. This is not a contract; rather, it is an agreement to work with us. We ask for these signatures to ensure support for the program from the practice’s leadership and to approve the minimum time commitment of 2 hours per month per care center. However, the actual program commitments/requirements will be fulfilled by the stewardship team and frontline staff.

10. Is a data use agreement (DUA) required to participate in the program?

No, a DUA is not required for participation in the program. The data are being collected both for program assessment purposes and as a tool for each site’s own quality improvement efforts. Each site should use the data it collects to evaluate its antibiotic use and antibiotic stewardship efforts. NORC and Johns Hopkins Medicine will use the collected data to assess the adoption and effectiveness of the program overall. Additionally, each site can compare its antibiotic use to similar facilities.

Since the program is only requesting deidentified information and is not requesting any protected health information (PHI), a data use agreement is not required for participation in this program. However, if your practice determines that it still needs a DUA to define the transaction, we can provide a template for your review.

11. What material do I need to complete before the program begins?

You need to complete the online application and a letter of commitment. The letter of commitment should be signed by an office manager and a medical director or other physician champion.

This program does not involve human subjects research, so no institutional review board (IRB) approval is required. Your practice should be able to frame this program as a quality improvement study. Johns Hopkins Medicine has determined this program is not human subjects research (Johns Hopkins IRB #IRB00129058). If your practice requires an IRB submission for informational purposes, we will be glad to help you as needed.

12. Who is sponsoring the program?

This program is funded and guided by AHRQ, part of the U.S. Department of Health and Human Services. Johns Hopkins Medicine’s Armstrong Institute for Patient Safety and Quality is conducting the work in collaboration with NORC at the University of Chicago.

13. What data are being collected? Please see the tables below.

Data Collection Tools

Electronic Health Record Clinical Data Extracts

14. Will participants have to provide protected health information (PHI) about their patients?

The program only requests deidentified information; it does not request any PHI.

15. For what purpose will the data be used?

The data are being collected as a tool for quality improvement efforts and program assessment purposes. Each site should use the data it collects to evaluate its antibiotic use and antibiotic stewardship efforts. NORC at the University of Chicago and Johns Hopkins Medicine will use the collected data to assess the adoption and effectiveness of the program overall. Additionally, each site will receive a quarterly report so it can compare its antibiotic use to similar facilities. The program is collecting only deidentified data. Aggregate practice antibiotic use data will be shared with similar participating ambulatory practices for comparison purposes only. Individual participating ambulatory care practices will not be identified.

16. Where specifically will our data be shared, and will it be “published” with our practice identifiers?

The program only collects deidentified data. Your data will be aggregated, anonymized, and then shared for comparison purposes only with AHRQ and other similar ambulatory care practices participating in the program. Individual ambulatory care practices will not be identified.

17. Do the data need to be submitted in a specific format? Is this a file-based upload?

The antibiotic use data can be uploaded to the Web site. As an example, if your practice is able to generate antibiotic use data in an Excel file using the program-supplied template, the Excel file can be directly uploaded to the program Web site. Information on data submission is available on the program Web site, and the national program team can discuss with you the most feasible submission process for your practice.

20. Are the monthly Webinars more about antibiotic stewardship or clinical instruction for management of infectious diseases?

The monthly Webinars focus on (1) how to improve communication with patients and families about indications for antibiotic therapy; (2) how to improve communication within a practice regarding antibiotic prescribing; and (3) discussions of best practices for common infectious syndromes (e.g., adult sinusitis, acute bronchitis, chronic sinusitis, acute otitis externa, community-acquired pneumonia, influenza, upper respiratory tract infections, acute pharyngitis, cellulitis, and urinary tract infections).

21. Who should participate in the Webinars?

The project lead(s) (i.e., clinician lead and office manager) and clinical staff should participate in the monthly Webinars. Clinical staff includes all individuals who are responsible for communicating with patients around antibiotics or ordering, administering, or monitoring the use of antibiotics, including nurse practitioners, physicians, physician assistants, nurses, pharmacists, medical assistants, and front desk staff. We recognize that not all frontline clinical staff can be on each Webinar due to clinical responsibilities, so we recommend designating at least one or two frontline providers to attend each Webinar in real time and report back to the rest of the team on the topic covered. The slides and accompanying facilitator guides for all Webinars also will be available on the program Web site for staff who are unable to be on the live Webinars, and audio presentations will be available for some topics. In addition, all participating staff will be provided with a user name and password to access the program Web site, which contains all educational content related to the program.

22. How does this program relate to the quality reporting goals for the Merit-based Incentive Payment System (MIPS)?

Participation in the AHRQ Patient Safety Program for Improving Antibiotic Use will help you fulfill your quality reporting goals for the Merit-based Incentive Payment System (MIPS), one of two tracks under the Medicare Access and CHIP Reauthorization Act (MACRA). The Program will help you meet MIPS quality measures related to several different conditions such as adult sinusitis, acute bronchitis, chronic sinusitis, and acute otitis externa.