A more accurate alternative to self-reported surveillance for antimicrobial resistance: Quis custodiet ipsos custodies?
Author(s): ,
Tjibbe Donker
Affiliations:
University of Oxford
,
Timo Smieszek
Affiliations:
Public Health England
,
Katherine Henderson
Affiliations:
Public Health England
,
Timothy Walker
Affiliations:
University of Oxford
,
Russell Hope
Affiliations:
Public Health England
,
Alan Johnson
Affiliations:
Public Health England
,
Neil Woodford
Affiliations:
Public Health England
,
Derrick Crook
Affiliations:
University of Oxford
,
Tim Peto
Affiliations:
University of Oxford
,
Sarah Walker
Affiliations:
University of Oxford
Julie Robotham
Affiliations:
Public Health England
PHE ePoster Library. Donker T. 03/20/18; 205921; 12589
Tjibbe Donker
Tjibbe Donker
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Abstract
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Abstract Hospital performance is often measured using self-reported statistics, such as the occurrence of micro-organisms exhibiting antimicrobial resistance (AMR). The underlying idea is that by comparing these numbers, hospitals with high levels of AMR are encouraged to improve their performance. However, such programmes might not favour hospitals that develop and deploy screening programmes which would enhance detection, as this would lead to apparent increased numbers of cases.We modelled the spread of AMR within and between hospitals, as well as the financial pressures on these hospitals. Using this model, we propose a surveillance system based on the observed number of imported cases from other hospitals. Using data from the NHS Hospital Episode Statistics, we obtain the number of participating hospitals required to deliver reliable estimates of incidences.We show that short-term cost can hinder hospitals increasing their screening and testing rates, in particular if hospitals are fined for the cases they report. Instead, if hospitals are rewarded for reporting cases found among patients that were previously admitted to another hospital, these hospitals will be driven to screen more patients.Self-reported statistics are unlikely to give a clear and comparable overview of hospital status and improve performance simultaneously if reported cases are costly. By separating the reporting of AMR incidences from the task of improving performance, the proposed surveillance scheme aligns incentives to increase screening efforts for AMR. Funding The research was funded by the National Institute for Health Research Health Protection Research Unit (NIHR HPRU) in Healthcare Associated Infections and Antimicrobial Resistance at University of Oxford in partnership with Public Health England (PHE). The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR, the Department of Health or Public Health England.
Abstract Hospital performance is often measured using self-reported statistics, such as the occurrence of micro-organisms exhibiting antimicrobial resistance (AMR). The underlying idea is that by comparing these numbers, hospitals with high levels of AMR are encouraged to improve their performance. However, such programmes might not favour hospitals that develop and deploy screening programmes which would enhance detection, as this would lead to apparent increased numbers of cases.We modelled the spread of AMR within and between hospitals, as well as the financial pressures on these hospitals. Using this model, we propose a surveillance system based on the observed number of imported cases from other hospitals. Using data from the NHS Hospital Episode Statistics, we obtain the number of participating hospitals required to deliver reliable estimates of incidences.We show that short-term cost can hinder hospitals increasing their screening and testing rates, in particular if hospitals are fined for the cases they report. Instead, if hospitals are rewarded for reporting cases found among patients that were previously admitted to another hospital, these hospitals will be driven to screen more patients.Self-reported statistics are unlikely to give a clear and comparable overview of hospital status and improve performance simultaneously if reported cases are costly. By separating the reporting of AMR incidences from the task of improving performance, the proposed surveillance scheme aligns incentives to increase screening efforts for AMR. Funding The research was funded by the National Institute for Health Research Health Protection Research Unit (NIHR HPRU) in Healthcare Associated Infections and Antimicrobial Resistance at University of Oxford in partnership with Public Health England (PHE). The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR, the Department of Health or Public Health England.
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