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Trick William

Description

Despite decades of attempts to promote judicious AU, the US has high rates of per-person antimicrobial consumption, and extremely high rates of carbapenem use. Such profligate use is a key factor in the high rate of antimicrobial-resistant infections seen in US healthcare facilities. Antimicrobial stewardship (AS) programs have been identified as a critical component of intervention strategies. A core component of AS programs is tracking AU, which is needed to monitor trends in use, focus interventions on aberrant behaviors, promote judicious use, and evaluate the effectiveness of interventions. A system designed to extend two national data models would provide a scalable platform for rapid adoption of AU reporting.

Objective:

Plan, develop, and pilot an open source system that could be integrated into the PCORnet (PCORI) and Sentinel (FDA) national common data models (CDMs) to generate antimicrobial use (AU) reports submittable to CDC’s National Healthcare Safety Network (NHSN). The system included ancillary tables, and data quality and report generation queries. The DataMIME system will allow hospitals to generate comparable AU reports for hospital inpatients.

Submitted by elamb on
Description

Meaningful Use (MU) Stage 2 public health reporting for Eligible Professionals (EPs) included a menu option for ambulatory syndromic surveillance. Review of currently existing models lead to a collaboration between the Illinois Health Information Exchange (ILHIE) and IDPH to build services that would support the use of the MPI, a database that can uniquely match records across systems. The MPI providers a mechanism for public health to manage multiple data streams, while maintaining confidentiality of health information and supporting the mission of public health to identify patterns of illness, apply effective interventions and conduct program evaluation. This initiative will allow IDPH to extend the use of the MPI to other surveillance domains, including hospital discharge, communicable disease, cancer and extensively drug resistance organism reporting.

Objective

This presentation will describe public health efforts to improve data collection by utilizing technology that supports record linkage through the implementation of the Master Patient Index (MPI). The initial use case will be applied to ambulatory syndromic surveillance at Illinois Department of Public Health (IDPH). It will include applications for incorporating the MPI into currently existing public health surveillance data and benefits to data integration and bidirectional information exchange.

Submitted by teresa.hamby@d… on
Description

CRE are multidrug-resistant bacteria associated with up to 50 percent mortality in infected persons. CRE are increasingly problematic in Illinois healthcare facilities, especially long-term acute care hospitals (LTACHs); therefore, Illinois implemented the eXtensively Drug-Resistant Organism (XDRO) registry (www.xdro. org). Mathematical models have identified patient sharing between healthcare facilities as a mechanism for regional spread, and the importance of each facility within a network can be quantified using social network analysis. Degree centrality is a measure representing the number of facilities with which a facility has shared at least one patient, and hence, a measure of “risk” of receiving a CRE colonized patient. Eigenvector centrality is more sophisticated in that it quantifies how well a given node is connected to other “wellconnected” nodes. We expect that facilities that have high degree and/or eigenvector centrality – and, thus, higher “risk” of encountering a CRE colonized patient – will have higher incidence of CRE, as will facilities that share patients with LTACHs. Understanding facilitylevel characteristics that predict higher CRE rates will enhance the XDRO registry’s usefulness as a surveillance tool.

Objective

To enhance CRE surveillance and communication by incorporating social network measures to quantify patient sharing between facilities.

Submitted by teresa.hamby@d… on
Description

CRE are drug-resistant bacteria that have a mortality rate of up to 50% in those infected. Several clusters of CRE have been detected in Illinois, often in long-term acute care hospitals. In response, Illinois created the XDRO registry, a mandatory reporting system designed to aid inter-facility communication concerning CRE.

Despite being a high priority for control in the US, the case definition for CRE has been the subject of debate3. There are over 70 Enterobacteriaceae which can have different mechanisms of carbapenem resistance. Criteria for carbapenem resistance include susceptibility results and phenotypic or genotypic detection. The case definition for the XDRO registry is intentionally more exclusive (specific) than that used by CSTE (Table 1). CSTE utilizes a definition designed to maximize sensitivity. Illinois’ XDRO registry’s definition is more specific, meant to reduce unnecessary adoption of contact precautions and the negative consequences some patients may experience.

Currently, case reporting to the XDRO registry is a manual data entry process, which has important advantages. However, transitioning to automatic ELR integration will streamline the reporting process and minimize data entry effort. Unfortunately, the clinical information needed to investigate XDROs is often not captured by ELR. The eCR is a new message type being piloted in Illinois that contains many clinical data elements. We examined the feasibility of combining ELR and eCR into reports for the XDRO registry. In the construction of these reports, we examined the impact of using CRE definitions from CSTE and the XDRO registry. 

Objective

To streamline carbapenem-resistant enterobacteriaceae (CRE) surveillance by integrating electronic laboratory reporting (ELR) data and electronic case reports (eCR) automatically into Illinois’ extensively drug-resistant organism (XDRO) registry. 

Submitted by Magou on