Abstract：
BACKGROUND: The Korean government implemented financial incentives to enhance infection prevention and management within general hospital settings. This study aimed to evaluate the impact of infection control compensation on antibiotic usage using a controlled interrupted time series analysis.
METHODS: The main unit of analysis was 270,901 inpatient episodes extracted from the Korean National Health Insurance Service Cohort Database from 2013 to 2019. The 96-month period was examined before and after the intervention, which was set to September 1, 2017, by applying a 1-year lag time after the incentive was introduced. Segmented regression was used to estimate the effects of interventions in a controlled interrupted time series. Hospitals that received nationwide financial incentives for infection prevention and management were included in the analysis. The study\'s primary outcome was the use of antibiotics based on the WHO Access, Watch, and Reserve (AWaRe) classification of antibiotics, and the secondary outcome was the number of days of antibiotic use as days of therapy (DOTs) per patient day (PD).
RESULTS: The probability of overall antibiotic use decreased between incentivized and unincentivized hospitals (odds ratio [OR], 0.922; 95% confidence interval [CI], 0.859-1.000). The difference in level change in the use of third-generation cephalosporins (OR,0.894; 95% CI, 0.817-0.977) and carbapenem (OR,0.790; 95% CI, 0.630-0.992) was significantly reduced between incentivized and unincentivized hospitals. The difference in slope change on DOTs/PD of glycopeptides was - 0.005 DOT/PDs, and that of carbapenem was - 0.003 between incentivized and unincentivized hospitals.
CONCLUSIONS: We observed that incentives for infection prevention and management have had a positive impact on some aspects of antibiotic usage. A partial decrease was observed in antibiotic use, accompanied by a modest reduction in DOTs/PD, particularly for antibiotics aimed at addressing multidrug-resistant pathogens. Further investigation is necessary to establish evidence for extending these incentives.
METHODS: The main unit of analysis was 270,901 inpatient episodes extracted from the Korean National Health Insurance Service Cohort Database from 2013 to 2019. The 96-month period was examined before and after the intervention, which was set to September 1, 2017, by applying a 1-year lag time after the incentive was introduced. Segmented regression was used to estimate the effects of interventions in a controlled interrupted time series. Hospitals that received nationwide financial incentives for infection prevention and management were included in the analysis. The study\'s primary outcome was the use of antibiotics based on the WHO Access, Watch, and Reserve (AWaRe) classification of antibiotics, and the secondary outcome was the number of days of antibiotic use as days of therapy (DOTs) per patient day (PD).
RESULTS: The probability of overall antibiotic use decreased between incentivized and unincentivized hospitals (odds ratio [OR], 0.922; 95% confidence interval [CI], 0.859-1.000). The difference in level change in the use of third-generation cephalosporins (OR,0.894; 95% CI, 0.817-0.977) and carbapenem (OR,0.790; 95% CI, 0.630-0.992) was significantly reduced between incentivized and unincentivized hospitals. The difference in slope change on DOTs/PD of glycopeptides was - 0.005 DOT/PDs, and that of carbapenem was - 0.003 between incentivized and unincentivized hospitals.
CONCLUSIONS: We observed that incentives for infection prevention and management have had a positive impact on some aspects of antibiotic usage. A partial decrease was observed in antibiotic use, accompanied by a modest reduction in DOTs/PD, particularly for antibiotics aimed at addressing multidrug-resistant pathogens. Further investigation is necessary to establish evidence for extending these incentives.
摘要：
背景：韩国政府实施了财政激励措施，以加强综合医院内的感染预防和管理。本研究旨在使用受控中断时间序列分析评估感染控制补偿对抗生素使用的影响。
方法：分析的主要单位是从2013年至2019年韩国国家健康保险服务队列数据库中提取的270,901例住院事件。在干预前后检查了96个月的时间，通过在引入激励措施后应用1年的滞后时间，将其设置为2017年9月1日。分段回归用于估计受控中断时间序列中干预措施的效果。分析中包括了接受全国财政奖励以预防和管理感染的医院。该研究的主要结果是使用基于WHO获取的抗生素，观看,和抗生素的储备(AWARE)分类，次要结局是抗生素使用天数,即每患者日(PD)的治疗天数(DOTs).
结果：在有激励和无激励的医院之间，总体抗生素使用的可能性降低(比值比[OR]，0.922；95%置信区间[CI]，0.859-1.000）。使用第三代头孢菌素的水平变化差异（OR，0.894；95%CI，0.817-0.977）和碳青霉烯（OR，0.790；95%CI，0.630-0.992）在激励医院和未激励医院之间显着降低。糖肽的DOTs/PD的斜率变化差异为-0.005DOT/PD,碳青霉烯的激励和非激励医院之间的-0.003。
结论：我们观察到感染预防和管理的激励措施对抗生素使用的某些方面产生了积极影响。观察到抗生素使用部分减少，伴随着DOTs/PD的适度减少，特别是针对针对多重耐药病原体的抗生素。有必要进一步调查以建立扩展这些激励措施的证据。
方法：分析的主要单位是从2013年至2019年韩国国家健康保险服务队列数据库中提取的270,901例住院事件。在干预前后检查了96个月的时间，通过在引入激励措施后应用1年的滞后时间，将其设置为2017年9月1日。分段回归用于估计受控中断时间序列中干预措施的效果。分析中包括了接受全国财政奖励以预防和管理感染的医院。该研究的主要结果是使用基于WHO获取的抗生素，观看,和抗生素的储备(AWARE)分类，次要结局是抗生素使用天数,即每患者日(PD)的治疗天数(DOTs).
结果：在有激励和无激励的医院之间，总体抗生素使用的可能性降低(比值比[OR]，0.922；95%置信区间[CI]，0.859-1.000）。使用第三代头孢菌素的水平变化差异（OR，0.894；95%CI，0.817-0.977）和碳青霉烯（OR，0.790；95%CI，0.630-0.992）在激励医院和未激励医院之间显着降低。糖肽的DOTs/PD的斜率变化差异为-0.005DOT/PD,碳青霉烯的激励和非激励医院之间的-0.003。
结论：我们观察到感染预防和管理的激励措施对抗生素使用的某些方面产生了积极影响。观察到抗生素使用部分减少，伴随着DOTs/PD的适度减少，特别是针对针对多重耐药病原体的抗生素。有必要进一步调查以建立扩展这些激励措施的证据。
