Efforts to promote optimal antibiotic use should employ both the public health and healthcare systems. To facilitate this relationship, the Public Health Foundation (PHF) led an effort to develop and pilot a driver diagram for public health and healthcare to work together to reduce antibiotic resistant infections. 

PHF partnered with the Centers for Disease Control and Prevention (CDC) and the Institute for Healthcare Improvement (IHI) to develop a framework of key drivers for reducing inappropriate antibiotic utilization in hospitals. The IHI Driver Diagram focused on hospital-based drivers (e.g., consider local antibiotic susceptibility patterns in selecting therapy, monitor for toxicity and adjust dose promptly); it focused on decreasing adverse drug events, pathogen prevalence, infection incidence, and pharmacy costs within acute care environments. During this process, PHF recognized that hospital-based efforts will be most effective when paired with community-based change efforts to address drivers of optimal antibiotic use beyond hospital walls.
 
The Public Health Antibiotic Stewardship Driver Diagram
PHF led the development of a framework for determining and aligning actions that can be taken across sectors for achieving antibiotic stewardship. An interdisciplinary team of experts in quality improvement (QI), infection control, epidemiology, and public health leadership, identified primary and secondary drivers of optimal antibiotic use to reduce the spread of antibiotic resistant infections and other adverse impacts of inappropriate antibiotic use. The resulting Public Health Antibiotic Stewardship Driver Diagram maps drivers of optimal antibiotic use—as a companion to the IHI diagram described above. While some drivers of optimal antibiotic use fall outside the direct control of public health (e.g., use of antibiotics in livestock food supplies), others sit squarely within the focus of the public health system.

 

When used together, the Public Health Antibiotic Stewardship Driver Diagram and the IHI Antibiotic Stewardship Driver Diagram provide a comprehensive framework for promoting optimal antibiotic use.

 

Public Health Antibiotic Stewardship Piloting
PHF facilitated collaborative pilot efforts between public health and healthcare systems to demonstrate the value of the Public Health Antibiotic Stewardship Driver Diagram. Read how Connecticut Department of Public Health, Independence Health Department, and Maine Center for Disease Control and Prevention created strategies and took steps to implement measureable improvements.

 

Population Health Driver Diagram Approach
PHF has used the population health driver diagram approach to address other health topics that require a multi-sectoral approach such as diabetes prevention and control and opioid use. PHF also developed a tool to help communities use a population health driver diagram as a starting point for discussion among stakeholders and to help create an atmosphere of cooperation by enabling each participant to identify their organization’s role.

 

For more information or to share how you’re using these tools and resources in your organization, contact Vanessa Lamers at vlamers@phf.org.