In a first-of-its-kind study to evaluate the impact of a medical specialty on patient outcomes, researchers found that 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. The study, which analyzed nearly 130,000 Medicare patient records, is now available online and will be published in the December 1 issue of Clinical Infectious Diseases.
Researchers found that patients treated by ID specialists are 9 percent less likely to die in the hospital and 12 percent less likely to die after discharge. When an ID physician is consulted, patients experience an average 3.7 percent fewer days in an intensive care unit. The study also found consultation with an ID specialist minimizes the likelihood patients will be readmitted to the hospital within 30 days.
“Infectious diseases are the second leading cause of death worldwide. In an age where healthcare-acquired infections are linked to payment penalties and bundled payments leave little room for error, the impact of ID physicians is more critical than ever to providing high quality care,” said Steven K. Schmitt, MD, lead author of the study. “As the ‘detectives’ of the medical world, ID specialists have additional years of training and possess the expertise to quickly identify and treat potentially life-threatening infections.”
In the study, researchers looked at a sample of Medicare patients who were hospitalized between Jan. 1, 2008 and Dec. 31, 2009 and had at least one of 11 serious but commonly treated infections: bacteremia, C diff, central line associated bloodstream infections (CLABSI), bacterial endocarditis, human immunodeficiency virus (HIV)/opportunistic infections, meningitis, osteomyelitis, prosthetic joint infections, septic arthritis, septic shock, and vascular device infections. Matching patient characteristics, researchers compared the outcomes of 61,680 hospitalized patients who saw an ID specialist to 65,192 hospitalized patients who did not see an ID specialist.
The benefits of ID consultation are more pronounced when patients are seen earlier, researchers note. Patients seen by an ID physician within two days of being admitted to the hospital are 6 percent less likely to be readmitted to the hospital within 30 days of discharge compared to patients seen by an ID physician after the first two days. These patients also have an average 3.8 percent fewer days in the hospital, and total Medicare costs for these patients are nearly 6.2 percent lower in the 30 days after discharge from the hospital.
“These findings are in line with healthcare reform efforts being implemented through the Affordable Care Act, showing that including ID specialists in up-front care of patients provides better outcomes at lower costs,” said Dr. Schmitt. “Further, the association of ID specialist involvement with reduced readmission rates suggests an important role for the infectious diseases specialist in transitions of care from the hospital to the community.”
Infectious diseases specialists are physicians who completed residency training in a specialty such as internal medicine or pediatrics and have undergone at least two to three years of additional, specialized training in infectious diseases. ID specialists play a critical role in the treatment and prevention of infections by managing: appropriate antibiotic choice, duration of therapy, route of delivery, and adverse drug reactions. An estimated 7,500 board certified ID specialists are practicing in the United States today, which has grown from fewer than 1,000 physicians in the early 1980s.
ID specialists are commonly called upon in major public health crises, including outbreaks of emerging infectious diseases, to educate the public, define treatment, and help halt the spread of rapidly communicable illnesses.
Diseases that used to have high morbidity and mortality rates, such as polio, smallpox, measles, influenza, mumps, and rubella, have been significantly curtailed or eradicated thanks to traditional ID strategies of surveillance and immunization. The demand for ID specialists is increasing as the need for specialized care to treat, prevent and study HIV, viral hepatitis, influenza, antibiotic resistant infections, and the list of ever-evolving microbes that cause human diseases continues to grow.
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The Infectious Diseases Society of America (IDSA) is an organization of physicians, scientists, and other health care professionals dedicated to promoting health through excellence in infectious diseases research, education, prevention, and patient care. The Society, which has more than 10,000 members, was founded in 1963 and is based in Arlington, VA. For more information, see www.idsociety.org.
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