Journal article
Association of Evidence-Based Care Processes With Mortality in Staphylococcus aureus Bacteremia at Veterans Health Administration Hospitals, 2003-2014
JAMA internal medicine, Vol.177(10), pp.1489-1497
10/01/2017
DOI: 10.1001/jamainternmed.2017.3958
PMCID: PMC5710211
PMID: 28873140
Abstract
Staphylococcus aureus bacteremia is common and frequently associated with poor outcomes. Evidence indicates that specific care processes are associated with improved outcomes for patients with S aureus bacteremia, including appropriate antibiotic prescribing, use of echocardiography to identify endocarditis, and consultation with infectious diseases (ID) specialists. Whether use of these care processes has increased in routine care for S aureus bacteremia or whether use of these processes has led to large-scale improvements in survival is unknown. To examine the association of evidence-based care processes in routine care for S aureus bacteremia with mortality. This retrospective observational cohort study examined all patients admitted to Veterans Health Administration (VHA) acute care hospitals who had a first episode of S aureus bacteremia from January 1, 2003, through December 31, 2014. Use of appropriate antibiotic therapy, echocardiography, and ID consultation. Thirty-day all-cause mortality. Analyses included 36 868 patients in 124 hospitals (mean [SD] age, 66.4 [12.5] years; 36 036 [97.7%] male), including 19 325 (52.4%) with infection due to methicillin-resistant S aureus and 17 543 (47.6%) with infection due to methicillin-susceptible S aureus. Risk-adjusted mortality decreased from 23.5% (95% CI, 23.3%-23.8%) in 2003 to 18.2% (95% CI, 17.9%-18.5%) in 2014. Rates of appropriate antibiotic prescribing increased from 2467 (66.4%) to 1991 (78.9%), echocardiography from 1256 (33.8%) to 1837 (72.8%), and ID consultation from 1390 (37.4%) to 1717 (68.0%). After adjustment for patient characteristics, cohort year, and other care processes, receipt of care processes was associated with lower mortality, with adjusted odds ratios of 0.74 (95% CI, 0.68-0.79) for appropriate antibiotics, 0.73 (95% CI, 0.68-0.78) for echocardiography, and 0.61 (95% CI, 0.56-0.65) for ID consultation. Mortality decreased progressively as the number of care processes that a patient received increased (adjusted odds ratio for all 3 processes compared with none, 0.33; 95% CI, 0.30-0.36). An estimated 57.3% (95% CI, 48.4%-69.9%) of the decrease in mortality between 2003 and 2014 could be attributed to increased use of these evidence-based care processes. Mortality associated with S aureus bacteremia decreased significantly in VHA hospitals, and a substantial portion of the decreasing mortality may have been attributable to increased use of evidence-based care processes. The experience in VHA hospitals demonstrates that increasing application of these care processes may improve survival among patients with S aureus bacteremia in routine health care settings.
Details
- Title: Subtitle
- Association of Evidence-Based Care Processes With Mortality in Staphylococcus aureus Bacteremia at Veterans Health Administration Hospitals, 2003-2014
- Creators
- Michihiko Goto - Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa CityMarin L Schweizer - Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa CityMary S Vaughan-Sarrazin - Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa CityEli N Perencevich - Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa CityDaniel J Livorsi - Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa CityDaniel J Diekema - Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa CityKelly K Richardson - Center for Comprehensive Access and Delivery Research and Evaluation, Iowa City Veterans Affairs Health Care System, Iowa City, IowaBrice F Beck - Center for Comprehensive Access and Delivery Research and Evaluation, Iowa City Veterans Affairs Health Care System, Iowa City, IowaBruce Alexander - Center for Comprehensive Access and Delivery Research and Evaluation, Iowa City Veterans Affairs Health Care System, Iowa City, IowaMichael E Ohl - Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City
- Resource Type
- Journal article
- Publication Details
- JAMA internal medicine, Vol.177(10), pp.1489-1497
- Publisher
- United States
- DOI
- 10.1001/jamainternmed.2017.3958
- PMID
- 28873140
- PMCID
- PMC5710211
- ISSN
- 2168-6106
- eISSN
- 2168-6114
- Language
- English
- Date published
- 10/01/2017
- Academic Unit
- Health Management and Policy; Epidemiology; Pathology; Internal Medicine
- Record Identifier
- 9983779498602771
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