Expanding What We Know About Smart Use of Antibiotics

February 26, 2024 · Andy Reynolds

Responsible Stewards of Antibiotic Use, our project to spread the word about smart use of antibiotics, has progressed to the second phase.  

This milestone matters for two reasons: 

• A new utilization measure increases our understanding. We’ve included Antibiotic Utilization for Respiratory Conditions (AXR) as the fourth HEDIS measure we use to track antibiotics stewardship. As a utilization measure, AXR evaluates how often a health plan prescribes antibiotics across respiratory conditions to their members. That, in turn, helps a health plan gauge how the organization manages resources, such as antibiotics—a useful internal metric that becomes more valuable over time.
   
• Health equity pivot. We’re adapting our research to understand disparities in inappropriate antibiotic prescribing by race and ethnicity.  

The Big Picture    

More than 2.8 million antibiotic-resistant infections occur in the US each year. They kill more than 35,000 people. 

When bacteria become resistant to antibiotics, infections are harder to treat. Patients can become sicker as the bacteria multiply. Viruses—including COVID—don’t respond to antibiotics. 

The leading cause of antibiotic resistance is incorrect prescribing. This includes inappropriate antibiotic type, dosage, timing and duration. 

Improving antibiotic prescribing practices can help: 

• Treat infections. 
• Fight antibiotic resistance. 
• Protect patients from the harms of unnecessary antibiotic use. 

Our Program 

In 2022, NCQA with support from the Pew Charitable Trusts launched the Responsible Stewards of Antibiotic Use Program to focus on the role health plans play in antibiotic stewardship.  

In the project’s first phase, we built and distributed free resources to help health plans get better at managing antibiotics. These include:  

• A five-part educational webinar series. 
• A guide to appropriate use of antibiotics. 
• An “honor roll” of high-performing health plans to emulate.  

We focused on three antibiotics-related HEDIS measures: 

• Appropriate Testing for Pharyngitis (CWP). 
• Appropriate Treatment for Upper Respiratory Infection (URI). 
• Avoidance of Antibiotic Treatment for Acute Bronchitis/Bronchiolitis (AAB). 

Go Deeper  

Adding AXR to our analysis gives us more information about antibiotic utilization.  

Using AXR also means we’re getting the most out of a measure that’s new to HEDIS. It followed our typical sequence for how we update HEDIS:   

• First-year reporting. We added AXR to HEDIS in Measurement Year (calendar year) 2022. Health plans collected data for AXR throughout 2022 and reported results to NCQA privately (not publicly disclosed) in summer 2023.  
• Public reporting. Full, official use of the measure and disclosure of results for Measurement Year 2023 will occur in summer 2024.  
• Benchmarking. Commercial, Medicare and Medicaid plans’ 2023 AXR results will be available in Quality Compass in late 2024. 

Pivoting Responsible Stewards of Antibiotic Use to focus on health equity means we will explore how our four measures can identify equity gaps in performance.  

This exploration includes: 

• Investigating differences across regions and product lines (commercial, Medicaid, Medicare). 
• Stratifying our four measures of antibiotics stewardship by race and ethnicity. 

The Bottom Line 

• Overuse of antibiotics is a longstanding menace to public health that is too important to ignore.  
• Our antibiotics program’s pivot to health equity is part of NCQA’s commitment to weave health equity into all of our products and programs.
• NCQA is grateful to the Pew Charitable Trusts for their continued support of this valuable, rewarding work.