Infectious Diseases Specialty Intervention is Associated with Decreased Mortality and Lower Healthcare Costs.
Clin Infect Dis. 2013 Sep 25;
Authors: Schmitt S, McQuillen DP, Nahass R, Martinelli L, Rubin M, Schwebke K, Petrak R, Ritter JT, Chansolme D, Slama T, Drozd EM, Braithwaite SF, Johnsrud M, Hammelman E
Background. Previous studies have demonstrated that infectious diseases (ID) specialists positively impact patient outcomes, but are largely based on chart reviews with small sample sizes. We investigate 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 with inpatient hospitalizations between 2008 and 2009 involving at least one of 11 infections. There were 101,991 stays with ID interventions and 170,336 stays without ID interventions. These cohorts were propensity score matched based on patient demographics, co-morbidities, and hospital characteristics. Regression models compared ID versus non-ID intervention cohorts and early versus late ID intervention cohorts. Risk-adjusted outcomes included hospital and ICU 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], 0.83-0.91) and readmissions (OR, 0.96; 95% CI, 0.93-0.99) compared to the non-ID intervention cohort. Medicare charges and payments were not significantly different; the ID intervention cohort LOS was 1.3% (95% CI, 0.5%-2.1%) longer, but ICU LOS was 3.7% shorter (95% CI, -5.5%--1.9%). Patients receiving ID intervention within 2 days of admission had significantly lower 30 day mortality, 30 day readmission, hospital and ICU length of stay, and Medicare charges and payments compared to patients receiving later ID interventions. Conclusions. ID interventions are associated with improved patient outcomes. Early ID interventions are associated with improved outcomes and reduced costs for Medicare beneficiaries with select infections.
PMID: 24072931 [PubMed - as supplied by publisher]