Indirect Standardization as a Case Mix Adjustment Method to Improve Comparison of Children's Hospitals' Antimicrobial Use.

Journal Article (Journal Article)

Antimicrobial use (AU) in days of therapy per 1000 patient-days (DOT/1000 pd) varies widely among children's hospitals. We evaluated indirect standardization to adjust AU for case mix, a source of variation inadequately addressed by current measurements. Hospitalizations from the Pediatric Health Information System were grouped into 85 clinical strata. Observed to expected (O:E) ratios were calculated by indirect standardization and compared with DOT/1000 pd. Outliers were defined by O:E z-scores. Antibacterial DOT/1000 pd ranged from 345 to 776 (2.2-fold variation; interquartile range [IQR] 552-679), whereas O:E ratios ranged from 0.8 to 1.14 (1.4-fold variation; IQR 0.93-1.05). O:E ratios were moderately correlated with DOT/1000 pd (correlation estimate 0.44; 95% confidence interval, 0.19-0.64; Pā€…=ā€….0009). Using indirect standardization to adjust for case mix reduces apparent AU variation and may enhance stewardship efforts by providing adjusted comparisons to inform interventions.

Full Text

Duke Authors

Cited Authors

  • Wattier, RL; Thurm, CW; Parker, SK; Banerjee, R; Hersh, AL; Pediatric Health Information System Antimicrobial Stewardship Research Group,

Published Date

  • September 7, 2021

Published In

Volume / Issue

  • 73 / 5

Start / End Page

  • 925 - 932

PubMed ID

  • 33320178

Electronic International Standard Serial Number (EISSN)

  • 1537-6591

Digital Object Identifier (DOI)

  • 10.1093/cid/ciaa1854


  • eng

Conference Location

  • United States