Dale W. Bratzler

Background: Unplanned healthcare utilization events, including hospital readmissions and emergency room visits, are common in patients receiving outpatient parenteral antimicrobial therapy (OPAT). Little is known about patient adherence to therapy in this setting. This clinical trial evaluates the impact of a remote therapeutic monitoring (RTM) device with an integrated care platform on all-cause healthcare utilization in patients on OPAT. Methods: This prospective, open-label, nonrandomized study enrolled patients discharged on OPAT to receive the IV Ensure RTM device compared to contemporaneous controls. The primary outcome was all-cause healthcare utilization, including hospital readmission or emergency room visit, assessed at day 90 after discharge. Adherence to antimicrobial therapy was evaluated in the intervention group. Results: A total of 81 patients were enrolled in the intervention group, with 131 patients in the control group. Both groups had similar baseline and OPAT characteristics. On multivariate Cox regression analysis, the RTM intervention was associated with a 39% reduction in all-cause healthcare utilization by day 60 (adjusted hazard ratio, 0.61 [95% confidence interval, .38–.96]; P = .03]) and a 38% reduction by day 90 (0.62 [.40–.95]; P = .03). In the intervention group, the overall adherence reached a median of 94%, and 61.7% of patients maintained adherence of >90% throughout their OPAT course. Conclusions: An RTM device with an integrated care platform significantly reduced all-cause healthcare utilization events in patients on OPAT.

Purpose: This study investigated changes in students’ attitudes using 2 validated interprofessional survey instruments—the Collaborative Healthcare Interdisciplinary Relationship Planning (CHIRP) instrument and the Interprofessional Attitudes Scale (IPAS)—before and after didactic and clinical cohorts.Methods: Students from 7 colleges/schools participated in didactic and clinical cohorts during the 2017–2018 year. Didactic cohorts experienced 2 interactive sessions 6 months apart, while clinical cohorts experienced 4 outpatient clinical sessions once monthly. For the baseline and post-cohort assessments, 865 students were randomly assigned to complete either the 14-item CHIRP or the 27-item IPAS. The Pittman test using permutations of linear ranks was used to determine differences in the score distribution between the baseline and post-cohort assessments. Pooled results were compared for the CHIRP total score and the IPAS total and subdomain scores. For each score, 3 comparisons were made simultaneously: overall baseline versus post-didactic cohort, overall baseline versus post-clinical cohort, and post-didactic cohort versus post-clinical cohort. Alpha was adjusted to 0.0167 to account for simultaneous comparisons.Results: The baseline and post-cohort survey response rates were 62.4% and 65.9% for CHIRP and 58.7% and 58.1% for IPAS, respectively. The post-clinical cohort scores for the IPAS subdomain of teamwork, roles, and responsibilities were significantly higher than the baseline and post-didactic cohort scores. No differences were seen for the remaining IPAS subdomain scores or the CHIRP instrument total score.Conclusion: The IPAS instrument may discern changes in student attitudes in the subdomain of teamwork, roles, and responsibilities following short-term clinical experiences involving diverse interprofessional team members.

The shift from volume-based to value-based reimbursement has created a need for quantifying clinical performance of ID physicians. Nationally recognized ID specialty-specific quality measures will allow stakeholders, such as patients and payers, to determine the value of care provided by ID physicians and will promote clinical quality improvement. Few ID-specific measures have been developed and, herein, we provide an overview of the importance of quality measurement for ID, discuss issues in quality measurement specific to ID, and describe standards by which candidate quality measures can be evaluated. If ID specialists recognize the need for quality measurement then ID specialists can direct ID-related quality improvement, quantify the impact of ID physicians on patient outcomes, compare their performance to that of peers, and convey to stakeholders the value of the specialty.

Surgical site infections (SSIs) are infections of the incision or organ or space that occur after surgery.¹ Surgical patients initially seen with more complex comorbidities² and the emergence of antimicrobial-resistant pathogens increase the cost and challenge of treating SSIs.^3- 5 The prevention of SSI is increasingly important as the number of surgical procedures performed in the United States continues to rise.^6,7 Public reporting of process, outcome, and other quality improvement measures is now required,^8,9 and reimbursements¹⁰ for treating SSIs are being reduced or denied. It has been estimated that approximately half of SSIs are preventable by application of evidence-based strategies.¹¹

We aimed to measure the association between 2013 guideline concordant prophylactic antibiotic use prior to surgery and infection with Clostridium difficile. We conducted a retrospective case-control study by selecting patients who underwent a surgical procedure between January 1, 2012 and December 31, 2013. Large urban community hospital. Cases and controls were patients age 18+ years who underwent an eligible surgery (i.e., colorectal, neurosurgery, vascular/cardiac/thoracic, hysterectomy, abdominal/pelvic and orthopedic surgical procedures) within six months prior to infection diagnosis. Cases were diagnosed with C. difficile infection while controls were not. The primary exposure was receiving (vs. not receiving) the recommended prophylactic antibiotic regimen, based on type and duration. Potential confounders included age, sex, length of hospital stay, comorbidities, type of surgery, and prior antibiotic use. Crude and adjusted odds ratios (OR) and 95% confidence intervals (CI) were calculated using logistic regression. We enrolled 68 cases and 220 controls. The adjusted OR among surgical patients between developing C. difficile infection and not receiving the recommended prophylactic antibiotic regimen (usually receiving antimicrobial prophylaxis for more than 24 hours) was 6.7 (95% CI: 2.9–15.5). Independent risk factors for developing C. difficile infection included having severe comorbidities, receiving antibiotics within the previous 6 months, and undergoing orthopedic surgery. Adherence to the recommended prophylactic antibiotics among surgical patients likely reduces the probability of being case of C. difficile. Antibiotic stewardship should be a priority in strategies to decrease the morbidity, mortality, and costs associated with C. difficile infection.

Interprofessional education (IPE) involving an interactive and longitudinal clinic experience at an inner-city charitable clinic from September to May 2013/2014 was evaluated. Pre-, mid-, and post-intervention data were collected from students in 13 different professions including medicine (medical and physician assistant), dentistry (dental and dental hygiene), nursing (undergraduate and clinical nurse specialist), public health, pharmacy, physical therapy, occupational therapy, nutritional sciences, speech and language pathology, and social work. To evaluate their interprofessional attitudes, students completed the TeamSTEPPS Teamwork Attitudes Questionnaire (T-TAQ) and Readiness for Interprofessional Learning Scale (RIPLS). They also completed a unique measure, healthcare professionals circles diagrams (HPCDs), that indicated student conceptualisation of a healthcare team caring for a complex patient, along with perception of their team’s progress towards meeting patient goals. Results from the T-TAQ and RIPLS scores indicated small but significant increases from pre- to post-intervention (p = 0.005 and 0.012, respectively). Analysis of the HPCDs revealed significant increases in students’ perceptions of the types of interprofessional team members, relationships, and communication between professions to provide medical care to patients (p < 0.01). Most HPCDs included pharmacists, nurses, and physicians as part of the care team at all time points. Students significantly increased their inclusion of dentistry, public health, social work, and physician assistants as members of the healthcare team from pre- to post-intervention. Implications of our data indicated the importance of IPE interventions that include not only classroom-based sessions, but actual patient care experiences within interprofessional teams. It also reinforced the importance of new and unique methods to assess IPE.