The value of specialist care—infectious disease specialist referrals—why and for whom? A retrospective cohort study in a French tertiary hospital

Abstract : This study evaluated the impact of infectious disease (ID) specialist referrals on outcomes in a tertiary hospital in France. This study tackled methodological constraints (selection bias, endogeneity) using instrumental variables (IV) methods in order to obtain a quasi-experimental design. In addition, we investigated whether certain characteristics of patients have a bearing on the impact of the intervention. We used the payments database and ID department files to obtain data for adults admitted with an ID diagnosis in the North Hospital, Marseille from 2012 to 2014. Comparable cohorts were obtained using coarsened exact matching and analysed using IV models. Mortality, readmissions, cost (payer perspective) and length of stay (LoS) were analysed. We recorded 15,393 (85.97%) stays, of which 2,159 (14.03%) benefited from IDP consultations. The intervention was seen to significantly lower the risk of inpatient mortality (marginal effect (M.E) = –19.06%) and cost of stay (average treatment effect (ATE) = – €5,573.39). The intervention group was seen to have a longer LoS (ATE = +4.95 days). The intervention conferred a higher reduction in mortality and cost for stays that experienced ICU care (mortality: odds ratio (OR) =0.09, M.E cost = –8,328.84 €) or had a higher severity of illness (mortality: OR=0.35, M.E cost = –1,331.92 €) and for patients aged between 50 and 65 years (mortality: OR=0.28, M.E cost = -874.78 €). This study shows that ID referrals are associated with lower risk of inpatient mortality and cost of stay, especially when targeted to certain subgroups.
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European Journal of Clinical Microbiology and Infectious Diseases, Springer Verlag, 2017, 36 (4), pp.625-633. 〈http://link.springer.com/article/10.1007/s10096-016-2838-y〉. 〈10.1007/s10096-016-2838-y〉
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http://www.hal.inserm.fr/inserm-01415611
Contributeur : Manoj Sasikumar <>
Soumis le : mardi 13 décembre 2016 - 12:48:37
Dernière modification le : lundi 10 septembre 2018 - 17:22:02

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Manoj Sasikumar, Sylvie Boyer, Anne Remacle-Bonnet, Bruno Ventelou, Philippe Brouqui. The value of specialist care—infectious disease specialist referrals—why and for whom? A retrospective cohort study in a French tertiary hospital. European Journal of Clinical Microbiology and Infectious Diseases, Springer Verlag, 2017, 36 (4), pp.625-633. 〈http://link.springer.com/article/10.1007/s10096-016-2838-y〉. 〈10.1007/s10096-016-2838-y〉. 〈inserm-01415611〉

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