Power BI視覺化儀表板於醫院抗生素管理計畫之應用

Utilizing Microsoft Power BI Dashboards to Visualize Antibiotic Use in Hospital Antibiotic Stewardship Programs

「監測抗微生物製劑使用」是醫療院所進行抗生素管理計畫中重要的一環。商業智慧(business intelligence, BI)具備資料整合、資料視覺化、即時互動等特色，目前已有醫療領域導入運用並頗具成效。本研究描述Power BI儀表板的建置過程，並探討導入視覺化儀表板於醫院抗生素管理計畫之應用成果。收集2021年1月至2023年12月院內抗生素耗用量、門急診就診人次、住院人日數、抗生素處方明細、感染科醫師抗生素審核資料，以及特定抗藥性菌株數量。Power BI儀表板使用多種視覺化功能，以敘述性統計進行資料分析。研究期間建置5種儀表板：(1)門急診與住院抗生素耗用密度；(2)單一抗生素使用情形；(3)抗生素耗用密度管制圖趨勢；(4)抗藥性菌株與特定抗生素耗用密度分析；(5)感染科醫師第二線管制性抗生素審核率分析。透過儀表板監測應用成果如下：(1)即時發現2021年第三季骨科門診口服levofloxacin耗用密度增加至29.7，專科醫師介入評估後同年第四季耗用密度下降至10.2。(2) 2023年5月引進困難梭狀桿菌毒素聚合連鎖檢測，同年第三季口服vancomycin處方量有下降趨勢。(3)感染科醫師管制性抗生素審核率每季皆達標且維持70%以上。Power BI視覺化儀表板可即時分析使用趨勢及異常用量，有效提昇抗生素使用及感染控制相關管理品質。

Tracking antibiotic use is a crucial element in hospital antibiotic stewardship programs. Considering that Microsoft Power BI offers customized dashboards for effective data visualization, we aimed to assess the effectiveness of these dashboards in combination with other interventions in antibiotic stewardship programs. Data on antibiotic prescriptions, daily hospital visits, and multidrug-resistant bacterial counts were collected between January 2021 and December 2023. The dashboards implemented various types of visualizations, including bar and column charts, single numbers, combo charts, doughnut charts, line charts, matrix displays, pie charts, slicers, and tables. Descriptive statistics were used for the data analysis. In this study, we identified five types of dashboards for antibiotic use: (a) outpatient, inpatient, and emergency department defined daily dose per 1,000 inhabitants per day (DID); (b) antibiotic prescription data, such as glycopeptides; (c) control charts for carbapenems, fluoroquinolones, and glycopeptides; (d) combo charts presenting multidrug-resistant bacterial counts and DID consumption for carbapenems and glycopeptides; and (e) audit rates and approval status of reserve antibiotics by infectious disease specialists. The dashboards provided several valuable insights. First, a significant increase in levofloxacin oral tablet DID in orthopedics was observed during the third quarter of 2021. Effective audits resulted in a subsequent decline in DID in the following quarter. Second, an increasing trend was observed in the treatment of Clostridium difficile infections since 2022. However, orally administered vancomycin was occasionally prescribed by doctors due to positive GDH antigen and negative toxin A/B results, without PCR test results. Therefore, introducing the PCR test in May 2023 may improve the diagnosis of Clostridium difficile-associated diarrhea (CDAD). Finally, the audit rates of reserve antibiotics have consistently exceeded 70% every quarter since 2022. In summary, power BI dashboards offer a valuable tool for hospitals to understand antibiotic usage trends and identify anomalies. The dashboards assist hospital management in formulating strategies and improving various aspects of quality management.