The Centers of Disease Control and Prevention have called antibiotic resistance one of the most urgent threats to the public’s health. One in three antibiotic prescriptions is unnecessary, according to the CDC, which means that at least 30 percent of antibiotics prescribed in the United States simply were not needed. In 2015, the White House released The National Action Plan for Combating Antibiotic-Resistant Bacteria, which set a goal of reducing inappropriate outpatient use by at least half by 2020. But what about the antibiotics prescribed to patients when they are inpatient, at a hospital or long-term care facility?
Researchers in the University of Nevada, Reno’s College of Business and School of Community Health Sciences have teamed up to help inpatient settings, such as hospitals and skilled nursing facilities, better understand their rate of antibiotic prescriptions as well as to help them identify trends in antimicrobial resistance by patients of a similar demographic makeup.
The Department of Health & Human Services within the Centers for Medicare & Medicaid Services recently provided more than $487,000 in funding for the implementation of the Antimicrobial Resistance Intelligence System (ARIS). The system was developed by two faculty members at the University – James Wilson, M.D., associate research professor in the School of Community Health Sciences and director of the Nevada Medical Intelligence Center, and Amir Talaei-Khoei, assistant professor, Information Systems in the College of Business. ARIS is an online database that uses predictive analytic techniques by providing real-time data that has the potential to create a personalized medicine approach.
“In our current medical system, doctors evaluate the illness of a patient and then cross-reference which antibiotics are available to treat said illness along with which one has a more positive rate of success for the demographic they are treating,” Dr. Wilson said. “What this system allows us to do is fine tune our treatments to the patient by integrating historical and predicted data within the healthcare setting.”
According to Dr. Wilson, there are a lot of parameters that need to be taken into account when prescribing an antibiotic. There are different resistance patterns in different geographic locations, differences in patients who have been hospitalized than those who have not, and more variables.
“What this software allows us to do is take a community-based approach to help facilities stay ahead of some of the problems surrounding antimicrobial resistance,” Dr. Wilson said. “Nursing homes especially are excited that we’re providing this solution as it allows for more expedient access to critical data that can help their general population.”
Rachel Carr, a consultant pharmacist for IntegriCare, RX, has been using the ARIS system for one of the skilled nursing facilities she works with in northern Nevada. According to Carr, the Centers for Medicare & Medicaid Services require antibiotic stewardship programs in skilled nursing facilities, as they are traditionally settings where antibiotics can be overused.
“This software has really helped simplify and streamline complicated data,” Carr said. “ARIS helps analyze what types of resistance patterns we're seeing and makes it easier to look at that data and put it into a useful format. We can look at resistance patterns at our facilities and then use that information to develop empiric prescribing guidelines. Those guidelines are then shared with the providers.”
To best share this information, Carr said she works with facility medical directors to collaborate on the guidelines. Together, they develop a chart of the guidelines, which are distributed to the facility and are included in its policy and procedures.
Talaei-Khoei emphasized that this system was developed as a platform that can help take some of the pain out of data analysis.
“With more and more guidelines from CMS and the Joint Commission around antimicrobial stewardship, the need for more real-time data is greater than ever,” Talaei-Khoei said. “Pharmacists are the key people involved in this effort. Since they are the ones required to evaluate the data, they are best equipped to give data-driven recommendations and guidelines within in-patient facilities.”
Talaei-Khoei and Dr. Wilson have processed data from multiple types of healthcare facilities in Nevada. The object of the system, they say, is to take in the evidence and data, which will ensure physicians do not overprescribe antibiotics. While there are challenges, both believe that the predictive power is the beauty of the system.
“Right now, everyone is reacting to last year’s data,” Dr. Wilson said. “We use predictive algorithms to estimate what is going on today for more accurate outcomes.”
Currently, ARIS is the only system of its kind. The hope is that one day soon, ARIS and Electronic Medical Records will integrate.
“I believe antimicrobial resistance is the leading threat to public health in the 21st century,” Dr. Wilson said. “Nevada is taking the lead to find innovative solutions via this data-driven analysis. New medicine is data driven and, while there are challenges to ensure healthcare settings are making decisions based on that data, ARIS will help ensure patients are receiving the medicine they need.”