225. Neither Antimicrobial Decision Support nor Antimicrobial Appropriateness were Associated with Decreased Medical Costs
Session: Poster Abstract Session: Clinical Practice Costs, Informatics, and Telemedicine
Thursday, October 8, 2015
Room: Poster Hall
Posters
  • 225_IDWPOSTER.pdf (326.5 kB)
  • Background:

    Use of a computer decision support system (CDSS) for inpatient antimicrobial (AM) therapy is associated with appropriateness of AM courses. We hypothesized that CDSS use or AM appropriateness would be associated with decreased costs.

    Methods:

    We studied AM courses given to 500 randomly selected VA hospital inpatients between 2007 and 2008.  “CDSS cases” were those in which CDSS was used for ³50% of AMs used to treat the condition that led to an AM course (index condition). Blinded reviewers classified the index AM course as appropriate or not, considering drug selection, route, dose, and duration. Medical costs were extracted from the VA decision support system and were obtained from a corporate data warehouse maintained by the VA.

    Results:

    Costs for CDSS and for non-CDSS cases were not significantly different for all intervals examined; from time of diagnosis (DxT) to discharge (Table), DxT to 3 months later, and DxT to 6 months later. Increasing Charlson Comorbidity Score (p = 0.02), diagnostic category of the index condition (p < 0.001), and origin of infection (p < 0.001) were all associated with costs. Appropriateness of AM courses was not associated with cost differences. Results did not differ when analyses were restricted to cases in which antimicrobial courses were started in the Community Living Center (transitional care or rehabilitation units).

    Multivariable analysis of impact of selected variables on log10(costs), DxT to discharge

     

    Regression

    Coefficients

    95% CI

    P

    CDSS

    -.038

    -.13 - .05

    .41

    Charlson comorbidity index

    .023

    .004 - .04

    .02

    Index condition diagnostic category1

    .018

     .009 - .03

    <.001 

    Origin2

    .143

    .09 - .2

    <.001

    Index course appropriate

    -.062

    -.16 - .03

    .2

    1 Cellulitis, COPD exacerbation, genitourinary infection, pneumonia, or other infection

    2Healthcare-associated, nosocomial, or community-onset

    Additional variables used for multivariable regression analysis included ward, inpatient service, and provider training level

    Conclusion:

    Neither CDSS use nor antimicrobial appropriateness was associated with cost savings. This apparent lack of effect may reflect that the primary study hypothesis was incorrect and/or that the study was not adequately powered for this outcome.

    Nicholas Yared, M.D.1, James R. Johnson, MD, FIDSA, FACP, FRCPE2, Dimitri M. Drekonja, MD, MS, FIDSA3, Joseph R. Thurn, MD, MPH, FSHEA4, Galen M. Hamann, BSN5, Bobbie Masoud, PharmD6 and Gregory a. Filice, M.D.6, (1)Department of Infectious Diseases and International Medicine, University of Minnesota, Minneapolis, MN, (2)Department of Medicine, Division of Infectious Diseases and International Medicine, University of Minnesota, Minneapolis, MN, (3)Department of Medicine, Infectious Diseases, Minneapolis Veterans Affairs Health Care System, Minneapolis, MN, (4)Department of Medicine, Infectious Disease Section, Univ of Minnesota, Minneapolis, MN, (5)Department of Medicine, Infectious Disease Section, Minneapolis Veterans Affairs Medical Center, Minneapolis, MN, (6)Department of Medicine, Infectious Disease Section, Minneapolis Veterans Affairs Health Care System, Minneapolis, MN

    Disclosures:

    N. Yared, None

    J. R. Johnson, None

    D. M. Drekonja, None

    J. R. Thurn, None

    G. M. Hamann, None

    B. Masoud, None

    G. A. Filice, None

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