Infectious Diseases Specialty Intervention Is Associated With Decreased Mortality and Lower Healthcare Costs

February 28, 2014 at 9:38 pm

Clinical Infectious Diseases January 1, 2014 V.58 N.1 P.22-28

Steven Schmitt1, Daniel P. McQuillen2, Ronald Nahass3, Lawrence Martinelli4, Michael Rubin5, Kay Schwebke6, Russell Petrak7, J. Trees Ritter8, David Chansolme9, Thomas Slama10, Edward M. Drozd11, Shamonda F. Braithwaite11, Michael Johnsrud12, and Eric Hammelman11

1Department of Infectious Diseases, Medicine Institute, Cleveland Clinic, Ohio

2Center for Infectious Diseases and Prevention, Lahey Hospital & Medical Center, Tufts University School of Medicine, Burlington, Massachusetts

3ID Care, Hillsborough, New Jersey

4Covenant Health, Lubbock, Texas

5Divisions of Clinical Epidemiology and Infectious Diseases, University of Utah School of Medicine, Salt Lake City

6OptumInsight, Eden Prairie, Minnesota

7Metro ID Consultants, LLC, Burr Ridge, Illinois

8French Hospital Medical Center, San Luis Obispo, California

9Infectious Disease Consultants of Oklahoma City, Oklahoma

10Indiana University School of Medicine, Indianapolis, Indiana

11Data Analytics

12Health Economics and Outcomes Research, Avalere Health, Washington, D.C.

Correspondence: Steven Schmitt, MD, 9500 Euclid Ave., Desk G-21, Cleveland, OH 44195, USA (schmits@ccf.org).

Background

Previous studies, largely based on chart reviews with small sample sizes, have demonstrated that infectious diseases (ID) specialists positively impact patient outcomes. We investigated how ID specialists impact mortality, utilization, and costs using a large claims dataset.

Methods

We used administrative fee-for-service Medicare claims to identify beneficiaries hospitalized from 2008 to 2009 with at least 1 of 11 infections. There were 101 991 stays with and 170 336 stays without ID interventions. Cohorts were propensity score matched for patient demographics, comorbidities, and hospital characteristics. Regression models compared ID versus non-ID intervention and early versus late ID intervention. Risk-adjusted outcomes included hospital and intensive care unit (ICU) length of stay (LOS), mortality, readmissions, hospital charges, and Medicare payments.

Results

The ID intervention cohort demonstrated significantly lower mortality (odds ratio [OR], 0.87; 95% confidence interval [CI], .83 to .91) and readmissions (OR, 0.96; 95% CI, .93 to .99) than the non-ID intervention cohort. Medicare charges and payments were not significantly different; the ID intervention cohort ICU LOS was 3.7% shorter (95% CI, −5.5% to −1.9%). Patients receiving ID intervention within 2 days of admission had significantly lower 30-day mortality and readmission, hospital and ICU length of stay, and Medicare charges and payments compared with patients receiving later ID interventions.

Conclusions

ID interventions are associated with improved patient outcomes. Early ID interventions are also associated with reduced costs for Medicare beneficiaries with select infections.

PDF

http://cid.oxfordjournals.org/content/58/1/22.full.pdf+html

Editorial Commentary

Infectious Diseases: A Friend in Need

Emilio Bouza

Department of Microbiology and Infectious Diseases, Hospital General Gregorio Marañón

Department of Medicine, Universidad Complutense, Madrid, Spain

Correspondence: Emilio Bouza, MD, PhD, Servicio de Microbiología y E. Infecciosas, Hospital General Universitario Gregorio Marañón, Dr Esquerdo 46, 28007 Madrid (ebouza@microb.net).

Schmitt et al must be congratulated for their effort to provide evidence to third-party payers on the convenience and advantages to consult infectious diseases specialists early, at least for patients with severe, nosocomially acquired infectious complications [1]. In a very interesting article published in this issue of the journal, they demonstrated that “ID interventions are associated with improved patient outcomes … and reduced costs” [1]. Their article has the added value of raising old and new issues that are not always approached similarly in different countries and in different situations.

The first issue that I would consider is the need for infectious diseases specialists at the present time. We are far from the years in which, in the pages of this very journal, prestigious physicians such as Petersdorf and Beeson bitterly discussed the need for more infectious diseases specialists [2–4]. In 1980, Beeson [5] claimed that our specialty lacks every attribute needed for successful practice: special technology, chronicity of disease, and balanced remuneration. Petersdorf, at that same time, suggested, “It is my conclusion that infectious disease is destined to function best as an academic specialty whose trainees should pursue careers …

PDF

http://cid.oxfordjournals.org/content/58/1/29.full.pdf+html

Entry filed under: Uncategorized.

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