InsightRX's Nova and Apollo platforms have given us powerful tools for improving the accuracy of vancomycin dosing.
Opportunity
Vancomycin is an antibiotic widely used in hospitals to treat infections. Vancomycin exposure under the target range for individual patients may be ineffective in treating infections. Conversely, exposure above the target range can cause acute nephrotoxicity and acute kidney injury (AKI), leading to worsening (and sometimes fatal) patient conditions, longer hospital stays, and higher costs of care. Nearly a half-million patients are impacted by AKIs in the U.S. each year, adding $4.7 billion to $24.0 billion to the nation's annual healthcare spending.1
Holyoke Medical Center (HMC), a 219-bed independent community hospital in western Massachusetts with more than 330 physicians and consulting staff and more than 1,600 employees, was focused on performance improvement initiatives related to target exposure measures when dosing patients with vancomycin.
Solution
HMC began using InsightRX's Nova precision dosing platform in 2020 and sought to fully leverage the solution for its performance improvement initiatives, especially the data available in Apollo.
To better understand the specific challenges with vancomycin target attainment, the InsightRX clinical team met with HMC staff over several weeks to discuss their data, find realistic avenues for improvement, and develop quality metrics for tracking performance. Using InsightRX Apollo data to enable its data-driven approach, HMC began measuring changes in target attainment rates after modifying its vancomycin dosing model and providing staff education. Working with the InsightRX team, HMC tested several different dosing models before settling on the newer default model that better reflected its patient population and improved target attainment scores.
Impact
The hospital compiled and compared InsightRX Apollo data from 514 patients receiving vancomycin doses between Jan. 1 and May 21, 2023, prior to implementing the new approach, with data from 176 patients who received vancomycin treatments between May 22 and Sept. 21, after the changes.
The data revealed that among all patients in both cohorts, target attainment rates were higher for patients receiving vancomycin doses after the new education and use of a newer model were implemented. Combining InsightRX's Apollo analytics data with pharmacist feedback and increased staff awareness enabled HMC to achieve significant, measurable improvement — nearly 30% — in average target attainment. Supported by InsightRX solutions, these outcomes were driven primarily by more conscious selection of regimens, aided by the use of a pharmacokinetic model better suited to HMC's patient population.
But we also knew that long-term success required building a data-driven, patient-centric culture at the hospital.
Results
Data-driven model optimization and a culture of daily performance review drove improvement
Working with the InsightRX team, HMC tested several different dosing models before settling on the newer default model that better reflected its patient population and improved target attainment scores.
This process of model optimization, guided by Apollo analytics showing how different models performed with HMC's specific patient demographics and characteristics, demonstrated the importance of tailoring precision dosing tools to local populations rather than adopting a one-size-fits-all approach. The ability to test and compare model performance using real patient data was crucial to identifying the optimal configuration. Thanks to these efforts, dosing performance data is a daily topic of conversation among pharmacists, ICU physicians, and other clinicians.
Figure 1 shows a sample plot from InsightRX Apollo clinical analytics software, depicting one aspect of model performance across several models — here showing a priori root mean square error (RMSE) for a selected population.
Using Apollo to review data and educate staff increased overall target attainment from 36.0% to 46.7%
Overall, average target attainment rates across the entire course of therapy rose from 36.0% to 46.7%, an increase of 29.7%. This improvement was achieved through a multi-pronged approach combining data analytics, optimization of the pharmacokinetic model, and targeted staff education. The InsightRX Apollo platform provided the visibility needed to identify improvement opportunities and track progress over time, while the clinical services team helped HMC staff interpret the data and develop actionable strategies.
Figure 2 shows an increase in target attainment post-process implementation. Routine data reviews, coupled with a change in culture and backed by expert support, helped increase target attainment in just a few months.
Conclusion
HMC's experience demonstrates the importance of data and analytics to support a multi-pronged approach to performance improvement. The case study highlights four best practices for other hospitals seeking to improve their vancomycin target attainment rates:
- Leverage your technology's clinical services
- Optimize the platform for your population
- Educate and involve your clinical staff
- Cultivate a data-driven culture
Combining the most appropriate pharmacokinetic model with training and a constant focus on improving target attainment scores through data analysis is a formula that can work for any hospital.