{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T19:10:24Z","timestamp":1791313824974,"version":"4.3.1"},"reference-count":30,"publisher":"Cambridge University Press (CUP)","issue":"9","license":[{"start":{"date-parts":[[2026,7,6]],"date-time":"2026-07-06T00:00:00Z","timestamp":1783296000000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["cambridge.org"],"crossmark-restriction":true},"short-container-title":["Infect. Control Hosp. Epidemiol."],"published-print":{"date-parts":[[2026,9]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec id=\"S0899823X26104978_as1\">\n                    <jats:title>Introduction:<\/jats:title>\n                    <jats:p>Benchmarking hospitals on their antibiotic use may be facilitated by metrics that adjust for inter-hospital differences in patient case-mix, such as types of infections, procedures, and comorbidities. Metrics that capture antibiotic spectrum [e.g., days of antibiotic spectrum coverage (DASC)] can be more sensitive to stewardship activities than metrics based on days of therapy (DOT). In this study, we developed risk-standardized metrics for both DOT and DASC.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"S0899823X26104978_as2\">\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>We performed a mixed-methods study to build risk-standardized metrics for inpatient antibiotic use, using a modified Delphi process integrating expert- and data-driven strategies to identify nonmodifiable risk factors associated with appropriate inpatient antibiotics. These factors were used to create risk-standardized ratios (RSR) for DOT and DASC. A standardized antimicrobial administration ratio (SAAR)-like metric was also constructed.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"S0899823X26104978_as3\">\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>In 2021, there were 497,061 patient-admissions across 121 Veterans Health Administration (VHA) hospitals. The median hospital RSR was 1.00 (interquartile range (IQR) 0.95\u20131.05) for DOT and 1.00 (IQR 0.96\u20131.04) for DASC; the median ratio for the SAAR-like metric was 0.85 (IQR 0.68\u20131.03). The Kendall\u2019s tau for RSR-DOT and the SAAR-like metric was 0.48; RSR-DASC and the SAAR-like metric was 0.33; and RSR-DOT and RSR-DASC were 0.48. Compared to the SAAR-like metric, 60 (49.6%) and 80 (66.1%) hospitals ranked in a different quartile for RSR-DOT and RSR-DASC, respectively.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"S0899823X26104978_as4\">\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>Hospital performance on the SAAR-like metric was weakly correlated with the RSR-DASC and moderately correlated with the RSR-DOT. Hospitals\u2019 performance on the SAAR-like metric differed from that of the RSR metrics, suggesting the RSR metrics may have added value over the SAAR.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1017\/ice.2026.10497","type":"journal-article","created":{"date-parts":[[2026,7,6]],"date-time":"2026-07-06T07:19:48Z","timestamp":1783322388000},"page":"938-948","update-policy":"https:\/\/doi.org\/10.1017\/policypage","source":"Crossref","is-referenced-by-count":1,"title":["Development of risk-standardized metrics for benchmarking hospitals on their inpatient antibiotic use"],"prefix":"10.1017","volume":"47","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8523-214X","authenticated-orcid":false,"given":"Daniel J.","family":"Livorsi","sequence":"first","affiliation":[{"id":[{"id":"https:\/\/ror.org\/036jqmy94","id-type":"ROR","asserted-by":"publisher"}],"name":"University of Iowa"},{"name":"Iowa City VAMC: Iowa City VA Medical Center"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8709-7914","authenticated-orcid":false,"given":"James A.","family":"Merchant","sequence":"additional","affiliation":[{"name":"Iowa City VAMC: Iowa City VA Medical Center"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hyunkeun","family":"Cho","sequence":"additional","affiliation":[{"name":"Iowa City VAMC: Iowa City VA Medical Center"},{"name":"University of California San Diego"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1832-7901","authenticated-orcid":false,"given":"Heather","family":"Davila","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/036jqmy94","id-type":"ROR","asserted-by":"publisher"}],"name":"University of Iowa"},{"name":"Iowa City VAMC: Iowa City VA Medical Center"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0511-7641","authenticated-orcid":false,"given":"Tamar F.","family":"Barlam","sequence":"additional","affiliation":[{"name":"Boston Medical Center"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sara E.","family":"Cosgrove","sequence":"additional","affiliation":[{"name":"Johns Hopkins Hospital: Johns Hopkins Medicine"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6993-4704","authenticated-orcid":false,"given":"Dimitri","family":"Drekonja","sequence":"additional","affiliation":[{"name":"Minneapolis VAHCS: Minneapolis VA Medical Center"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kelly","family":"Echevarria","sequence":"additional","affiliation":[{"name":"VHA Pharmacy Benefits Management Services: VHA Office of Pharmacy Benefits Manag"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4542-992X","authenticated-orcid":false,"given":"Matthew Bidwell","family":"Goetz","sequence":"additional","affiliation":[{"name":"VA Greater Los Angeles Healthcare System"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kevin","family":"Hsueh","sequence":"additional","affiliation":[{"name":"Washington University In St Louis: Washington University in St Louis"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kari A.","family":"Mergenhagen","sequence":"additional","affiliation":[{"name":"VA Western New York Healthcare System"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6622-4379","authenticated-orcid":false,"given":"Lindsay","family":"Taylor","sequence":"additional","affiliation":[{"name":"University of Wisconsin-Madison Molecular and Environmental Toxicology Center"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6612-5613","authenticated-orcid":false,"given":"Michihiko","family":"Goto","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/036jqmy94","id-type":"ROR","asserted-by":"publisher"}],"name":"University of Iowa"},{"name":"Iowa City VAMC: Iowa City VA Medical Center"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"56","published-online":{"date-parts":[[2026,7,6]]},"reference":[{"key":"S0899823X26104978_ref12","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/ciad189"},{"key":"S0899823X26104978_ref27","first-page":"378","article-title":"glmmTMB balances speed and flexibility among packages for zero-inflated generalized linear mixed modelling","volume":"9","author":"Brooks","year":"2017","journal-title":"The R Jouranl"},{"key":"S0899823X26104978_ref25","unstructured":"25. National Healthcare Safety Network. Antimicrobial Use and Resistance Module. Atlanta, GA, US Department of Health and Human Services, CDC, 2026. https:\/\/www.cdc.gov\/nhsn\/pdfs\/pscmanual\/11pscaurcurrent.pdf. Accessed April 20, 2026."},{"key":"S0899823X26104978_ref19","doi-asserted-by":"publisher","DOI":"10.1016\/S1473-3099(21)00626-5"},{"key":"S0899823X26104978_ref29","doi-asserted-by":"publisher","DOI":"10.1017\/ice.2024.137"},{"key":"S0899823X26104978_ref30","article-title":"Using encounter-level data for risk-adjustment of antimicrobial use comparisons: feasibility and variable selection","author":"Moehring","year":"2025","journal-title":"Clin Infect Dis"},{"key":"S0899823X26104978_ref28","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2004-0650"},{"key":"S0899823X26104978_ref17","doi-asserted-by":"publisher","DOI":"10.3389\/fpubh.2020.00457"},{"key":"S0899823X26104978_ref5","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/cir672"},{"key":"S0899823X26104978_ref6","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/ciy354"},{"key":"S0899823X26104978_ref16","doi-asserted-by":"publisher","DOI":"10.1287\/mnsc.9.3.458"},{"key":"S0899823X26104978_ref7","doi-asserted-by":"publisher","DOI":"10.1093\/jac\/dkn275"},{"key":"S0899823X26104978_ref4","doi-asserted-by":"publisher","DOI":"10.1093\/jac\/dkt458"},{"key":"S0899823X26104978_ref8","doi-asserted-by":"publisher","DOI":"10.1016\/j.jiph.2017.08.008"},{"key":"S0899823X26104978_ref26","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2025.14989"},{"key":"S0899823X26104978_ref22","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0020476"},{"key":"S0899823X26104978_ref11","doi-asserted-by":"publisher","DOI":"10.1017\/ice.2017.54"},{"key":"S0899823X26104978_ref9","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/ciaa1127"},{"key":"S0899823X26104978_ref2","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/ciy075"},{"key":"S0899823X26104978_ref21","volume-title":"RAND Methodological Guidance for Conducting and Critically Appraising Delphi Panels","author":"khodyakov","year":"2023"},{"key":"S0899823X26104978_ref14","doi-asserted-by":"publisher","DOI":"10.1017\/ice.2022.312"},{"key":"S0899823X26104978_ref13","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/ciab1034"},{"key":"S0899823X26104978_ref3","doi-asserted-by":"publisher","DOI":"10.1093\/jac\/dkr333"},{"key":"S0899823X26104978_ref15","doi-asserted-by":"publisher","DOI":"10.1017\/ice.2023.197"},{"key":"S0899823X26104978_ref1","doi-asserted-by":"crossref","first-page":"e702","DOI":"10.1093\/cid\/ciaa326","article-title":"National healthcare safety network standardized antimicrobial administration ratios (SAARs): a progress report and risk modeling update using 2017 data","volume":"71","author":"Edwards","year":"2020","journal-title":"Clin Infect Dis"},{"key":"S0899823X26104978_ref10","doi-asserted-by":"publisher","DOI":"10.1111\/1469-0691.12062"},{"key":"S0899823X26104978_ref20","doi-asserted-by":"publisher","DOI":"10.1001\/jamadermatol.2025.1115"},{"key":"S0899823X26104978_ref24","doi-asserted-by":"publisher","DOI":"10.1016\/j.jclinepi.2013.12.002"},{"key":"S0899823X26104978_ref18","doi-asserted-by":"publisher","DOI":"10.1097\/MD.0000000000032829"},{"key":"S0899823X26104978_ref23","doi-asserted-by":"publisher","DOI":"10.1017\/ash.2021.230"}],"container-title":["Infection Control &amp; Hospital Epidemiology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.cambridge.org\/core\/services\/aop-cambridge-core\/content\/view\/S0899823X26104978","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,8]],"date-time":"2026-09-08T12:59:52Z","timestamp":1788872392000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.cambridge.org\/core\/product\/identifier\/S0899823X26104978\/type\/journal_article"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,6]]},"references-count":30,"journal-issue":{"issue":"9","published-print":{"date-parts":[[2026,9]]}},"alternative-id":["S0899823X26104978"],"URL":"https:\/\/doi.org\/10.1017\/ice.2026.10497","relation":{},"ISSN":["0899-823X","1559-6834"],"issn-type":[{"value":"0899-823X","type":"print"},{"value":"1559-6834","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,6]]},"assertion":[{"value":"\u00a9 Veterans Health Administration, 2026","name":"copyright","label":"Copyright","group":{"name":"copyright_and_licensing","label":"Copyright and Licensing"}},{"value":"This is a work of the US Government and is not subject to copyright protection within the United States. Published by Cambridge University Press on behalf of The Society for Healthcare Epidemiology of America.","name":"license","label":"License","group":{"name":"copyright_and_licensing","label":"Copyright and Licensing"}},{"value":"This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (https:\/\/creativecommons.org\/licenses\/by\/4.0\/), which permits unrestricted re-use, distribution and reproduction, provided the original article is properly cited.","name":"license","label":"License","group":{"name":"copyright_and_licensing","label":"Copyright and Licensing"}},{"value":"This content has been made available to all.","name":"free","label":"Free to read"}]}}