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Management of Health Programs

Did it achieve what it was supposed to? Should it be continued or even replicated elsewhere? The article, Implementation of an antimicrobial stewardship program In a rural hospital addresses Antimicrobial Stewardship (AMASS) program and the growing concerns of the appropriate use of antimicrobial. The center for Disease control and Prevention launched a campaign to improve antimicrobial use through the implementation of AMASS programs. National and international organizations have recognized this growing problem and have published guidelines and recommendations to combat it (CDC, 2012).

Antimicrobial stewardship refers to coordinated interventions designed to improve and measure the appropriate use of antimicrobial by promoting the selection of the optimal antimicrobial drug regimen, dose, duration of therapy, and route of administration. Antimicrobial stewards seek to achieve optimal clinical outcomes related to antimicrobial use, minimize toxicity and other adverse events, reduce the costs of health care for infections, and Limit the selection for antimicrobial resistant strains.

Survey was completed to assess pharmacist Involvement In and the presence of antimicrobial surveillance In rural community hospitals in Idaho, Nevada, Utah and eastern Washington in 2000. In that availability. While many of the surveyed hospitals (71%) had policies in place with only 28% had systems in place for monitoring compliance

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with existing policies. (Yam, 2012). There are several different types of program evaluation available to managers. This include surveys, analysis of administrative data, key informant interview, observation and focus groups.

Surveys are a set of questions that are asked of everyone in the same way and you choose people randomly or systematically. Analysis of administrative data is the use of statistical analysis on program data that is already collected. Thirdly key informant interview are qualitative, in-depth interviews of 15 to 35 people selected for their first-hand knowledge about a topic of interest. Lastly focus groups, interviews and observation are qualitative research methods, that is, methods that are less likely to rely on statistical analysis.

With each of these program evaluation they have advantages and disadvantages. It is important to understand the advantages and disadvantage of your evaluation tools available to the managers. Surveys can answer questions about how many and how often for the entire client population either randomly or systematically. If you do not use one of these methods the disadvantage is that you cannot use the results of the survey to make conclusions about your client’s population.

Analysis of administrative data advantages is that (1) no new data collection is required, (2) many databases are relatively large and (3) data bay be available electronically. The disadvantages is that the data were gathered for another purpose, so may not have necessary variables and all administrative data sets, some fields are likely to be more accurate than others. Key informant interviews have a planned set of questions on he topic of interest and is useful to when candid information about sensitive topics are needed.

The disadvantage to this process is that you’re limiting the amount of input you will receive. Focus groups, interviews and observation advantages are that (1) help figure out major program problems that cannot be explained my more formal methods of analysis, (2) evaluator may see things that participants and staff may not see, (3) evaluator can learn about things which participants or staff may be unwilling to reveal in more formal methods and (4) when a main purpose is to generate recommendations.

Disadvantages with this process is (1) evaluators subjective views can introduce error, (2) focus of the evaluator is only on what is observed at one time in place and (3) focus groups could be dominated by one individual and their point of view. In the article, Implementation of an antimicrobial stewardship program in a rural hospital the program evaluation that the managers used was analysis of administrative data to grade their AMASS program.

The primary endpoints to be measured was (1) the number of interventions after the review of antimicrobial therapy by the clinical pharmacist, (2) the rate of empiric antimicrobial streamlining n the basis of culture results or elimination of redundant therapy, (3) third the percentage agreement between pharmacist and ID physician recommendations, (4) cost savings associated with AMASS activities and (5) Colostomies difficult infection rates before and after program implementation.

This program evaluation facilitates you’re asking if your organization is really doing the right program activities to bring clients (rather than Just engaging in busy activities which seem reasonable to be at the time) (Manager, 2006). The pharmacist review of antimicrobial therapy increased significantly over the first 13 month evaluation. The AMASS interventions per 1000 patient-days increased from the baseline rate of 2. 1 per week to more than 25 per week. A decrease in cost per 1,000 patient-days was seen during this period.

Antibiotic purchase costs decreased from $13,521 to $9,756 per 1,000 patient-days in 2010 and to $6,583 per 1,000 patient-days in the first two quarters of 2011 (Yam, 2012). This was more than a 50% reduction in cost during this outcome-based evaluation. The results of the AMASS program had a positive outcome and was the best approach. With the implementation of the program evaluation you need to take a look to see hat it revealed, did it achieve what it was supposed to and should it be continued or can it be replicated elsewhere.

The program evaluation saw an increase in pharmacist-recommended interventions and the streamlining of antimicrobial therapy as well as decreases in health care-associated C. difficult infections and antimicrobial purchasing costs. Meeting these key points achieved what the program was supposed to. The process should continue and continue to be evaluated into the future since the Antimicrobial prescribing restrictions did not exist at the hospital fore AMASS program initiation and were not implemented during the initial phase of the 13-month evaluation project.

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