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Purpose of measurement

A closer look at step 4 of setting up an AMS programme. Monitoring an evaluation.

In this activity, we will look at STEP 4 of setting up an AMS programme (ASP) – the monitoring and evaluation stage. This step involves:

  • Being able to monitor and assess the impact of an ASP through measurement.
  • Understanding the value of point prevalence studies.
  • How to communicate this measurement information to prescribers and leadership. In this first step, we will examine the purpose of measurement and why it is crucial.

Why is measurement important?

Lord Kelvin, a famous physicist, quoted:

“If you cannot measure it, you cannot improve it.” “When you can measure what you are speaking about and express it in numbers, you know something about it; but when you cannot measure it when you cannot express it in numbers, your knowledge is of a meagre and unsatisfactory kind.”

This is very pertinent to the context of ASPs.

As discussed back in step 2.2, the WHO toolkit (chapter 6) outlines the 3 different steps of measurement and the importance of measuring the quality of prescribing.

four types of measurement: structural, process, outcome, and balance

The ACSQHC has produced a helpful table (below) that shows examples of these four types of measures.

This infographic is also available as a screen-reader compatible PDF.

A 2017 study by Toma et al. examined the types of outcomes typically measured when evaluating AMS interventions. They demonstrated that many ASPs only review how effectively their interventions achieved the expected, desirable outcomes but neglected to consider any unintended consequences of the intervention, positive or negative. The study provides a framework for ensuring a balanced accounting of the impact of AMS interventions by considering potential pleasant and unpleasant ‘surprises’.

Purpose of Measurement

There are many reasons why measurement matters. One or more may apply to why measurement is being undertaken.

  • Continued local improvement/quality improvement.
  • Local benchmarking.
  • Comparison against standards for internal scrutiny, e.g. targets.
  • Comparison against standards for external scrutiny/quality assurance.
  • To provide evidence of the value of stewardship to hospital management, e.g. indicators.
  • Financial incentives or avoidance of penalties.
  • Publication of a research or audit study.
  • To find out if all the effort was worth it!

It is vital to collect data on your ASP for the following key purposes:

  • Accountability – judgement or scrutiny of performance.
  • Quality improvement.
  • Research to generate evidence.

Data play an important role in assessing AMS, although qualitative improvement can be achieved even in the absence of data. However, efficiently prioritising interventions and allocating resources requires data to identify critical challenges and demonstrate the impact of interventions. Indicators of antibiotic use, both the quantity used and the quality of prescribing, are thus essential parts of any AMS strategy.

The diagram below highlights the difference when data is collected for improvement compared to research or judgment.

This infographic is also available as a screen-reader compatible PDF.

Now you understand why measurement is so important to demonstrate the impact of an ASP, we will look at some of the options for using measures in evaluation.

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How to set up an Antimicrobial Stewardship Programme

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