1054. Impact of Prospective Review and Feedback with Peer Comparison on Carbapenem Utilization by Physicians Practicing at a Community Teaching Hospital

BACKGROUND: Behavioral interventions such as peer comparison have shown to reduce inappropriate antibiotic utilization in outpatient settings. We aimed to estimate the impact of prospective review and feedback with periodic peer comparison on carbapenem use by physicians in an inpatient setting. METHODS: Interrupted time series study conducted at a 400-bed community teaching hospital with an Antimicrobial Stewardship Program (ASP) in place since 2012. Prospective review and feedback is the ASPs main strategy. Carbapenem use is not restricted. The intervention was limited to internal medicine residents, system-employed hospitalists, critical care specialists, surgery residents and surgery attendings directly supervising residents. Each carbapenem day of therapy (DOT) was reviewed by an infectious diseases (ID) physician or ID pharmacist and classified as adequate, suboptimal unnecessary or inappropriate. For the purposes of peer comparison, each DOT was attributed to the physician directly responsible for patient care on the day a carbapenem was administered. Among patients admitted to teaching services, both the resident and their supervising attending were deemed responsible. Individual physicians’ proportions of adequate use were calculated and compared with the aggregate proportion of adequate use by service, i.e., hospitalists were compared with other hospitalists. An email summarizing utilization metrics and comparing to their peers was sent on a monthly basis. The main outcome of interest was hospital-wide carbapenem use measured in DOT per thousand patient-days. Carbapenem DOT use by service was a secondary outcome. Changes in post-intervention trends were calculated as incidence rate ratios (IRR). RESULTS: Following the onset of the intervention there were no changes in hospital-wide trends of carbapenem use (IRR 1.04; 95% CI 0.98–1.10; P = 0.21) (Figure 1). Analysis of carbapenem use by service showed prescribing trends remained stable within services, with IRR in medical service of 0.98 (95% CI 0.92–1.05; P = 0.61) and IRR in the surgical service of 1.05 (95% CI 0.99–1.13; P = 0.11) (Figures 2 and 3). No changes were seen in proportions of adequate use. CONCLUSION: Addition of peer comparison to an ASP utilizing prospective review and feedback did not decrease carbapenem use. [Image: see text] [Image: see text] [Image: see text] DISCLOSURES: All authors: No reported disclosures.