Blog | Friday, September 27, 2013

QD: News Every Day--Infectious disease specialists state case for seeing one sooner


Hospitalized patients with severe infections such as meningitis and Clostridium difficile (C. diff.) are significantly less likely to die if they receive care from an infectious diseases specialist, a study reported.

The study, commission by the Infectious Diseases Society of America, appeared online Sept. 25 and will appear in the Dec. 15 issue of Clinical Infectious Diseases.

In the study, researchers looked at Medicare fee-for-service patients who were hospitalized between Jan. 1, 2008 and Dec. 31, 2009 and had at least one of 11 infections: bacteremia, Clostridium difficile, central line associated bloodstream infections, bacterial endocarditis, HIV/opportunistic infections, meningitis, osteomyelitis, prosthetic joint infections, septic arthritis, septic shock and vascular device infections.

Researchers matched patients and evaluated the outcomes for 61,680 cases in which a hospitalized patient saw an infectious disease specialist to 65,192 cases that did not involve an infectious disease specialist.

Patients who saw an infectious disease specialist had significantly lower mortality (odds ratio [OR], 0.87; 95% CI, 0.83 to 0.91) and fewer readmissions (OR, 0.96; 95% CI, 0.93 to 0.99) compared to those who didn’t. Those who saw an infectious disease specialist had a longer length of stay (1.3% by days; 95% CI, 0.5% to 2.1%), but spent less time in the ICU (3.7% in days; -5.5% to -1.9%).

“Infectious diseases are the second leading cause of death worldwide. In an age where health care-acquired infections are linked to payment penalties and bundled payments leave little room for error, the impact of infectious disease physicians is more critical than ever in providing high quality care,” said lead author Steven K. Schmitt, MD, FACP, chair of the Infectious Disease Society of America’s Clinical Affairs Committee. “As the ‘detectives’ of the medical world, infectious disease specialists have additional years of training and possess the expertise to quickly identify and treat potentially life-threatening infections.”

Also, researchers noted, patients seen by an infectious disease physician within 2 days of being admitted to the hospital are 6% less likely to be readmitted to the hospital within 30 days of discharge compared to patients seen by one after the first 2 days.

“These findings are in line with healthcare reform efforts being implemented through the Affordable Care Act, which shows that including infectious disease specialists in up-front care of patients provides better outcomes at lower costs,” said Daniel F. McQuillen, MD, FACP, a co-author. “Further, the association of infectious disease specialist involvement with reduced readmission rates suggests an important role for the infectious disease physician in transitions of care from the hospital to the community.”