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The Steward-Ship Laveer

AMS Laveer 690 px

November, 2017


Welcome Aboard our AMS Newsletter

Welcome back Idaho and Washington Participants! Thank you to those who have completed the baseline assessment survey.  A summary of the surveys that we have collected to date is included below.  Providing this information to us will guide us to tailor future resources toward assisting you meet CDC’s Core Elements of Antibiotic Stewardship.

Tsunami Alert

Expect a flood of AMS announcements ahead!  World Antibiotic Week starts Monday,  November 13th through the 19th. You will hear about changes to CDC’s website as well as other announcements and resources from your other local partners in AMS.  STAY TUNED!

World Antibiotic Week links:

Through the Porthole – Your Monthly Resource

November’s AMS resource highlight focuses on the “EDUCATION AND EXPERTISE” Core Element.  Below we have two sources of education that can help your clinicians and your patients manage expectations about requesting (and prescribing) antibiotics.

For Providers
In August (8/30/17), the National Coordinating Center (NCC) hosted a provider-focused presentation on physician-to-patient communication strategies, “Understanding Physician-to-Patient Communication Strategies”.  We promoted this event in an earlier (8/18/17)  email, and many of you attended then and (hopefully) circulated the training around to your providers for continuing education credits.  Due to the popularity and positive reception of the presentation, we are steering those who “missed the boat” to Watch Drs. Hicks and Mangione-Smith presentation on our AMS Resources page, where links to the presentation slides and video can be found under the “Education and Expertise” section.

Communication skills between providers and patients are a recurring theme for AMS Core Elements. By focusing on these “parleys”, through providing and formalizing communication skills and training, you can get a lot of (nautical) miles out of your efforts.

*TIP* Routinely providing AMS education resources with continuing education activities to your providers helps meet the ongoing “EDUCATION AND EXPERTISE” Element.  Distributing this video to your clinicians is a great start!  If ALL of your providers routinely participate in AMS education activities with continuing medical education credits, and your facility records compliance with these trainings – this can meet the “TRACKING AND REPORTING” Element – this is a great option for smaller practices with ongoing AMS training resources.

*TIP* Providers who use recognized effective communication strategies (like the ones presented here) when discussing a patient’s care options, are helping educate their patients when antibiotics are and are not needed – the other side to meeting “EDUCATION AND EXPERTISE” evidence-based stewardship education to patients.

*TIP* Including formal provider education on communication skills (i.e. in orientation and/or annual competencies) can help you meet the “ACTION” Element – and ensure ongoing maintenance of this vital skill for successful provider/patient interactions, and sustained preservation of our antibiotics’ effectiveness.

For Your Patients
Here are two excellent resources for patient education on antibiotic use.

Choosing Wisely logo

Choosing Wisely:

Qualis Health is proud to support Choosing Wisely®, an initiative of the American Board of Internal Medicine (ABIM) Foundation, which aims to promote conversations between clinicians and patients by helping patients choose care that is:

  •     Supported by evidence
  •     Not duplicative of other tests or procedures already received
  •     Free from harm
  •     Truly necessary

Choosing Wisely has a “bounty” of patient-facing “treasure” for your front office and as hand-outs.

Our AMS Resource page now has a curated list of Choosing Wisely tools for you to consider for patient education.

Here you can jump straight to Choosing Wisely’s lists of resources which discuss antibiotics – provided by multiple professional associations.

Patient-friendly resources (use “antibiotics” as the search keyword)

Clinician lists of recommendations by professional associations (use “antibiotics” as the search keyword)

Center for Disease Control and Prevention:

The CDC website also has materials for patient education with a curated list on our resource page.  

NOTE: CDC’s site may have new link locations with new materials coinciding with a restructure and promotional campaign aligning with World Antibiotic Awareness Week.  We will attempt to keep our Resources Website up-to-date with these changes.

*TIP* Printing and providing the appropriate patient-education materials to support discussion of a treatment plan – whether patients are given an antibiotic prescription or not –  helps you meet part of the EDUCATION AND EXPERTISE Element.  Furthermore, discussing with them the potential harms of antibiotic use is recommended during these conversations.

*TIP* Remember to change up your resources – you may already have some patient brochures on antibiotic usage or appropriateness – but don’t be afraid to splash in some new information. These new resources may be just the “tailwind” your patients and providers need to change their minds and behaviors around antibiotics.

Check our all our updated "Education and Expertise" materials through our Resource Web Page for AMS!

All Hands – Information for All about the Initiative

Still getting your AMS “sea-legs” under you?  Check out these Qualis Health updates on the initiative:

Quality Payment Program - QPP performance period has left the dock! Thankfully, you’re all on board. To use antimicrobial stewardship as an Improvement Activity (IA) for 2017, you need to show 90 days of implementation.    Don’t worry – you began working with us in this Quality Improvement Project before July 31st, 2017 – when we ended recruiting.  Your signed letters of agreement are documentation that you are engaged in this project and working toward an antibiotic stewardship program.

All of these activities, and your ongoing efforts to achieve and maintain CDC’s Four Core Elements, (as reported in your assessment to us) can provide documentation for your IA. To use AMS for an IA, you should document “implementation of an antibiotic stewardship program that measures the appropriate use of antibiotics for several different conditions according to clinical guidelines for diagnostics and therapeutics and identifies improvement actions”.  To this end, we will provide your previously completed AMS assessments when we distribute the next follow-up assessment request – if not before.

Physician offices wanting help with AMS and earn credit toward their Quality Payment Program (QPP) reporting, can reach us at the QPP Resource Center, and at QPP@QualisHealth.org.

The Initial Baseline Assessment of your AMS Practices -   We’ve had a lot of you send us completed assessments, with great descriptions of your ongoing work, new ideas for expanding AMS, and requests for assistance.  Several of you have not yet completed the assessment: We will be tracking down and following up on these “castaway” reports over the next few weeks. If you know your practice hasn't completed this yet, please "dive in" and complete the baseline assessment now.

Below we have a snapshot of what Core Elements and actions have been completed by both states. Please scroll to the very end of this message to see your collective baseline efforts in developing and maintaining AMS programs.

Record Audit Tools - In addition to last month’s Bronchitis Self-Audit Worksheet, we now have a similar document for auditing your Viral Upper Respiratory Infection treatment. *TIP* Using this tool can help you meet the “TRACKING AND REPORTING” Element, and can help answer part of the question, “How many antibiotic prescriptions are NOT being given in your practice?”!

Data Overboard! We’ve had to “dry-dock” our antimicrobial use by Tax Identification Number (TIN) reports, and are working on a secure file-sharing system. These changes have caused a delay in getting you some initial information about your Medicare population antibiotic prescribing practices. However, we are continuing to provide you with additional approaches to meet the “TRACKING AND REPORTING” Element, and hope to get you further supplemental material soon.
Bi-monthly office-hours – Qualis Health staff will be “on deck” to answer any of your AMS Initiative questions, and help you find the resources you need to succeed.  Although you can reach out to our Quality Improvement Consultants any time – these scheduled times will include access to additional staff and experts in the field.  Our dates for our next office hours will be Thursday, November 9th, and Thursday January 11th.

We are excited for all of your enthusiasm about AMS and for this project. We hope to have “smooth sailing” as we continue helping you on your journey to meeting and maintaining your AMS programs.

From the Crow’s Nest – Overview of Progress for the Qualis Health AMS in Outpatient Settings Initiative

Thanks again for the baseline AMS assessments we have received so far!  As you can see below, some of you already have many AMS elements in place when we started this initiative, while others are just getting started; both are fine!  We encourage those who have already begun their AMS journey to continue to grow in their evidence-based application of AMS, through expanding surveillance and internal feedback to their providers, as well as formalizing AMS and provider communication resources into their orientation and annual competencies. Those practice newer to AMS - we hope to see you extend your AMS efforts into a few new activities this cold-and-flu season.

View Idaho Assessment Summary

View Washington State Assessment Summary