In the JournalsPerspective

Early ID consult improves outcomes for hospitalized patients

An infectious disease specialty intervention lowered mortality rates, reduced costs, and shortened the length of stay among hospitalized patients younger than 65 years of age, according to recent data published in Clinical Infectious Diseases. The results further showed that an early ID intervention was associated with better outcomes than later involvement.

Steven Schmitt, MD, FIDSA, FACP, staff physician in the infectious disease department at Cleveland Clinic, and colleagues said their findings build on a growing body of evidence demonstrating the benefits of ID consultation for patients, including those with cryptococcosis, Staphylococcus aureus bacteremia, drug-resistant pathogens and solid organ transplant recipients.

“Previous studies in the United States have been limited to individual centers or infections, or to Medicare recipients,” the researchers wrote. “The current study extends them by assessing results associated with ID care in the general hospital population for privately insured individuals under 65 years of age.”

The researchers conducted a retrospective analysis using administrative claims data from community hospitals and post-discharge ambulatory care facilities in the U.S. They performed two analyses. The first analysis included patients who had an early ID intervention, defined as an ID consult within the first 3 days of index hospitalization, as well as a matched cohort of patients who did not have an ID intervention (early/none cohort). The second analysis included patients who had an early ID intervention and those who had a late ID intervention, defined as an ID consult at day 4 or later (early/late cohort).

From 2013 to 2014, Schmitt and colleagues identified 76,608 index hospitalizations for bacterial endocarditis, bacteremia, central line-associated bloodstream infection, Clostridium difficile infection, meningitis osteomyelitis, prosthetic joint infection, septic arthritis, septic shock or vascular device infection. Of these hospitalizations, 29% (n = 22,213) had an early ID intervention.

In the early/none cohort, an early intervention was associated with a lower risk for mortality (OR = 0.658; 95% CI, 0.446-0.939) during the index hospitalization. The morality risk further decreased with a greater number of ID encounters (OR = 0.970; 95% CI, 0.926-0.999). Early interventions also reduced the length of hospital stay by 23% and costs by $10,888 compared with no intervention. After discharge, patients who received an early intervention were less likely to be readmitted within 30 days (OR = 0.804; 95% CI, 0.730-0.885) and spent $1,841.54 less in post-discharge costs.

In the early/late cohort, there was no significant difference in mortality between the groups. However, mortality was lower among patients with more ID encounters (OR = 0.973; 95% CI, 0.939-0.998). During the index hospitalization, early ID intervention reduced the length of stay (incidence rate ratio [IRR] = 0.710; 95% CI, 0.695-0.796) and costs by $20,264.59. Within the first 30 days after discharge, patients who received an early intervention had fewer readmissions (IRR = 0.816; 95% CI, 0.741-0.898) and spent $2,312.19 less in post-discharge costs.

Because of the lack of information available in claims data, the researchers were unable to further investigate the reasons for better outcomes among patients who had an early ID intervention. However, they said previous research has shown that ID physicians are more likely to prescribe the most appropriate therapy for the optimal duration, which can reduce infection recurrences and hospital readmissions.

“The generalizability of these results may be limited due to the inability of the data to answer key questions about prognosis and specific patient comorbidities or characteristics,” the researchers concluded. “The study was not designed to detect the precise components of costs that were saved in infection treatment, and delineation of these factors is a topic for future investigation.” – by Stephanie Viguers

Disclosures: Schmitt reports no relevant financial disclosures. Please see the full study for all other authors’ relevant financial disclosures.

An infectious disease specialty intervention lowered mortality rates, reduced costs, and shortened the length of stay among hospitalized patients younger than 65 years of age, according to recent data published in Clinical Infectious Diseases. The results further showed that an early ID intervention was associated with better outcomes than later involvement.

Steven Schmitt, MD, FIDSA, FACP, staff physician in the infectious disease department at Cleveland Clinic, and colleagues said their findings build on a growing body of evidence demonstrating the benefits of ID consultation for patients, including those with cryptococcosis, Staphylococcus aureus bacteremia, drug-resistant pathogens and solid organ transplant recipients.

“Previous studies in the United States have been limited to individual centers or infections, or to Medicare recipients,” the researchers wrote. “The current study extends them by assessing results associated with ID care in the general hospital population for privately insured individuals under 65 years of age.”

The researchers conducted a retrospective analysis using administrative claims data from community hospitals and post-discharge ambulatory care facilities in the U.S. They performed two analyses. The first analysis included patients who had an early ID intervention, defined as an ID consult within the first 3 days of index hospitalization, as well as a matched cohort of patients who did not have an ID intervention (early/none cohort). The second analysis included patients who had an early ID intervention and those who had a late ID intervention, defined as an ID consult at day 4 or later (early/late cohort).

From 2013 to 2014, Schmitt and colleagues identified 76,608 index hospitalizations for bacterial endocarditis, bacteremia, central line-associated bloodstream infection, Clostridium difficile infection, meningitis osteomyelitis, prosthetic joint infection, septic arthritis, septic shock or vascular device infection. Of these hospitalizations, 29% (n = 22,213) had an early ID intervention.

In the early/none cohort, an early intervention was associated with a lower risk for mortality (OR = 0.658; 95% CI, 0.446-0.939) during the index hospitalization. The morality risk further decreased with a greater number of ID encounters (OR = 0.970; 95% CI, 0.926-0.999). Early interventions also reduced the length of hospital stay by 23% and costs by $10,888 compared with no intervention. After discharge, patients who received an early intervention were less likely to be readmitted within 30 days (OR = 0.804; 95% CI, 0.730-0.885) and spent $1,841.54 less in post-discharge costs.

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In the early/late cohort, there was no significant difference in mortality between the groups. However, mortality was lower among patients with more ID encounters (OR = 0.973; 95% CI, 0.939-0.998). During the index hospitalization, early ID intervention reduced the length of stay (incidence rate ratio [IRR] = 0.710; 95% CI, 0.695-0.796) and costs by $20,264.59. Within the first 30 days after discharge, patients who received an early intervention had fewer readmissions (IRR = 0.816; 95% CI, 0.741-0.898) and spent $2,312.19 less in post-discharge costs.

Because of the lack of information available in claims data, the researchers were unable to further investigate the reasons for better outcomes among patients who had an early ID intervention. However, they said previous research has shown that ID physicians are more likely to prescribe the most appropriate therapy for the optimal duration, which can reduce infection recurrences and hospital readmissions.

“The generalizability of these results may be limited due to the inability of the data to answer key questions about prognosis and specific patient comorbidities or characteristics,” the researchers concluded. “The study was not designed to detect the precise components of costs that were saved in infection treatment, and delineation of these factors is a topic for future investigation.” – by Stephanie Viguers

Disclosures: Schmitt reports no relevant financial disclosures. Please see the full study for all other authors’ relevant financial disclosures.

    Perspective

    Photo of Michael Angarone

    Appreciation of the benefit of an ID consult for various infections has been demonstrated by numerous studies over the past few years. ID consultation results in lower 30-day mortality and relapse rates for Staphylococcus aureus bacteremia. Among Medicare recipients, ID intervention has demonstrated lower mortality rates and reduced costs when ID was involved in the care. The current study by Schmitt and colleagues demonstrates this benefit among younger patients with private insurance. Early ID intervention was associated with lower odds of death, shorter length of stay (LOS) and lower costs compared to no ID intervention. When compared to late ID intervention, early intervention was again associated with shorter LOS and reduced costs, as well as lower mortality and readmission rates 30 days post discharge. The bottom line for this study is that it adds to the growing body of evidence that an ID consultation leads to improved outcomes for patients co-managed over a variety of ID conditions and patient populations.

    References:

    Vogel M, et al. J Infect. 2016;doi:10.1016/j.jinf.2015.09.037.

    Schmitt S, et al. Clin Infect Dis. 2014;doi:10.1093/cid/cit610.

    Michael Angarone, DO

    Assistant professor of medicine (infectious diseases) and medical education
    Northwestern University Feinberg School of Medicine

    Disclosure: Angarone reports no relevant financial disclosures.