ID Consultants Lower Mortality and Cost of Hospital Stay
Abstract & Commentary
By Carol A. Kemper, MD, FACP
Clinical Associate Professor of Medicine, Stanford University, Division of Infectious Diseases, Santa Clara Valley Medical Center.
Dr. Kemper does research for Abbott Laboratories and Merck.
This article originally appeared in the November 2013 issue of Infectious Disease Alert. It was edited by Stan Deresinski, MD, FACP, FIDSA, and peer reviewed by Timothy Jenkins, MD. Dr. Deresinki is Clinical Professor of Medicine, Stanford University, Associate Chief of Infectious Diseases, Santa Clara Valley Medical Center, and Dr. Jenkins is Assistant Professor of Medicine, University of Colorado, Denver Health Medical Center. Dr. Deresinski does research for the National Institutes of Health, and is an advisory board member and consultant for Merck, and Dr. Jenkins reports no financial relationships relevant to this field of study.
Source: Schmitt S, et al. Infectious disease specialty intervention is associated with decreased mortality and lower healthcare costs. Clin Infect Dis, 2013 Sep 25 [Epub ahead of print].
The most heavily curb-sided specialty may also be one of the more valuable, especially in an era of cost-consciousness, and focus on quality markers such as shorter stays and fewer 30-day readmissions. The impact of ID consultation on important markers, such as length of ICU stay, length of hospital stay, mortality, and frequency of 30-day readmission was assessed for patients admitted to an acute care hospital (ACH) with at least one of 11 specific infections between January 2008 and November 2009. These common infections were selected based on the ability to query fee-for-service Medicare claims based on DRG code (bacteremia, C. difficile infection, central line-associated bloodstream infection, bacterial endocarditis, HIV, meningitis, osteomyelitis, prosthetic joint infections, septic arthritis, septic shock, and vascular device infections).
A total of 101,991 ACH stays with ID consultation and 170,366 without ID involvement (59.8%) were examined. Patients with ID consultation generally had more than one infection, and were more likely to be male, they were younger, more likely to be admitted to ICU, and were more likely admitted to a teaching hospital compared to those without ID intervention. From this cohort, the authors selected a matched sample of ACH hospitalizations that involved ID intervention (61,680) and that did not involve ID intervention (65,102). Prior to adjusting for any risk factors, patients with ID intervention generally appeared more ill, had longer lengths of hospital stay, more days in ICU, but a lower index stay mortality.
After adjustment for risk factors, cases with ID involvement had statistically significantly lower rates of index stay (odds ratio, .89), lower rates of 30-day mortality (OR, .86), and lower rates of 30-day readmissions (OR, .96). In addition, stays with ID involvement within the first 2 days of hospitalization were associated with a significantly lower 30-day mortality (OR, .87) and readmission rate (OR, 0.92). Furthermore, those cases were associated with a 3.8% reduction in overall hospital stay, 5.1% fewer ICU days, and significantly lower cost of hospital charges, Medicare payments to ACH, and Medicare payments to all providers. These differences were small (on the order of 2.9% to 6.2%) but highly statistically significant.
In a multivariate analysis using case controls, involvement of an ID specialist in the care of patients admitted to ACH resulted in improved outcomes and a lower cost of care, especially when the ID consultant was involved early in the hospitalization.