healthcare-associated infections (HAI) program

CDPH HAI Antimicrobial Stewardship Program (ASP) Honor Roll Outcomes

Part III - Demonstration of Outcomes (Required for Silver and Gold Designations)

Please make sure that answers are complete in the actual online application that includes clinically meaningful outcomes of an intervention from the three-year period prior to the application deadline, including data from the most recent one-year prior to the deadline.
The goal of this portion of the application is to determine if your program is effective beyond meeting criteria on a check list.
Reviewers of this portion of the application will evaluate as if it were a scientific abstract.
Note: External blinded AS expert reviewers may review Part III of your application. Please ensure that all facility identifying information is redacted in Part III only.
Please review the Rubrics below as applicable.
Optional: In addition to answering the questions on the application completely, you may upload additional documentation such as graphs, publication, abstract, poster, or report supporting the outcomes reported in the application.

Renewal Applicants

If you are renewing, you will be prompted to answer whether you are submitting a new intervention/project not previously submitted to the CDPH HAI ASP Honor Roll or submitting the same project with some changes.
If the project has been previously submitted, please make sure to describe the need as to why the intervention is ongoing, and what adjustments were made since the last application. Also provide updated results including the last year.

Examples of Clinically Meaningful Outcomes

Clinically meaningful infection treatment outcomes (e.g., clinical success/cure), CDI rates, prescribing behavior, adverse reactions, resistance rates, mortality, etc. Antibiotic use (e.g., days of therapy) alone is not sufficient. Please refer to Rubric below.

Examples of Interventions

Targeting fluoroquinolone use and susceptibility patterns in response to determining that your facility has been overprescribing or non-adherent to guidelines and found increased fluoroquinolone resistance among gram negatives.

Clinically meaningful outcomes would include resistance patterns and correlated fluoroquinolone DOT per 1000 pt. days
Intervention: prescriber-based intervention of antibiotic time-out targeted at levofloxacin use
Methods are data collected pre and post intervention. Antibiotic-time out prompts opened in the electronic medical record when a prescriber opens the patient’s profile on levofloxacin.

Targeting Staphylococcus aureus blood stream infection (SAB) due in response to high mortality rates and inappropriate antibiotics being started or delay in appropriate antibiotics started

Clinically meaningful outcomes may include SAB rates, treatment outcomes including mortality rates, time to initiate appropriate antibiotics in days, duration of therapy in days.
Intervention: implementation of SAB bundle using clinical decision support software
Methods: clinical decision support software to prompt providers with the SAB bundle order (includes initiating pre-selected antibiotics, TEE, ID consultation, etc.) when a positive blood culture reports SA.

Rubric for Outcomes (Part III) for Interventions/Projects Not Previously Submitted

QUESTIONS (Time frame should include most recent 1 year prior to deadline)	Enter the Following:
Was an outcome actually reported? 0 - Unclear 1 - Not explicitly stated, but discernable 2 - Purpose stated but outcome not explicitly stated 3 - Explicitly stated (measurable)	Number from scale
Was the outcome clinically meaningful? Use scale below. Examples (this is not a complete list - provide comments below): 0 - No outcome provided 1 - Antibiotic use only (alone is not considered clinically meaningful) 2 - Length of stay, re-admissions 3 - Antimicrobial resistance rates, appropriateness 4 - CDI, mortality, adverse events, clinical success/cure 5 - Behavioral changes in prescribing	Number from scale (Results must include actual data)
Originality. Use scale below. 0 - Partially or completely missing results or plan 1 - Old idea with no significant results 2 - Replicates important intervention done by others with significant results 3 - Original or innovative intervention (e.g. new population not previously described well)	Number from scale
Overall impression. Use scale below. 0 - Does not appear to be an effective/successful intervention 1 - Intervention is partially effective/successful 2 - Intervention is effective/successful 3 - Intervention serves as a model for others (sustainable changes/intervention)	Number from scale
Additional comments (general) Specific comments on Outcomes Specific comments on Clinically Meaningful Specific comments on Originality Specific comments on Overall Impression (accuracy of data, e.g. check denominators)	Constructive comments

Used by each reviewer for evaluating the outcomes (Part III) for each facility applying for Silver/Gold designation.

Note: Results of outcomes chosen do not necessarily need to be significant to be considered clinically meaningful.

Rubric for Outcomes (Part III) for Previously Submitted Interventions/Projects

QUESTIONS (Time frame should include most recent 1 year prior to deadline)	Enter the Following:
Need for continuing the intervention or project 0 - Unclear 1 - Not explicitly stated, but discernable 2 - Purpose stated with some description of need to continue 3 - Explicitly stated; demonstrated clear need for continuation	Number from scale
Was the outcome(s) clinically meaningful? Use scale below. Examples (this is not a complete list - provide comments below): 0 - No outcome provided 1 - Antibiotic use only (alone is not considered clinically meaningful) 2 - Length of stay, re-admissions 3 - Antimicrobial resistance rates, appropriateness 4 - CDI, mortality, adverse events, clinical success/cure 5 - Behavioral changes in prescribing	Number from scale (Results must include actual data)
Adjustment in methods or outcomes. Use scale below. 0 – No adjustment in methods or additional clinically meaningful outcomes compared to prior project with no updated results 1 – Minor adjustment in methods or additional clinically meaningful outcomes, but results are updated 2 - Moderate adjustment in methods or additional outcomes with moderate results 3 – Significant adjustment to methods or outcomes and significant results	Number from scale
Overall impression. Use scale below. 0 - Does not appear to be an effective/successful intervention 1 - Intervention is partially effective/successful 2 - Intervention is effective/successful 3 - Intervention serves as a model for others (sustainable changes/intervention)	Number from scale
Additional comments (general)	Constructive comments
Specific comments on Outcomes	Constructive comments
Specific comments on Clinically Meaningful	Constructive comments
Specific comments on Originality	Constructive comments
Specific comments on Overall Impression (accuracy of data, e.g. check denominators)	Constructive comments

Used by each reviewer for evaluating the outcomes (Part III) for each facility renewing for Silver/Gold designation.
Note: Results of outcomes chosen do not necessarily need to be significant to be considered clinically meaningful.

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