Clinicians who primarily practice in nursing homes and outcomes among residents with urinary tract infection or pneumonia
Abstract Objective: Assess the association between clinicians who primarily practice in nursing homes (NHs) and 14-day resident outcomes following initial antibiotic dispensing for pneumonia or urinary tract infection (UTI). Design: Retrospective cohort. Setting: U.S. NHs. Participants: NH r...
| Main Authors: | , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Cambridge University Press
2023-01-01
|
| Series: | Antimicrobial Stewardship & Healthcare Epidemiology |
| Online Access: | https://www.cambridge.org/core/product/identifier/S2732494X23005272/type/journal_article |
| _version_ | 1797352753598562304 |
|---|---|
| author | Melissa R. Riester Cody M. Douglas Joe B.B. Silva Rupak Datta Andrew R. Zullo |
| author_facet | Melissa R. Riester Cody M. Douglas Joe B.B. Silva Rupak Datta Andrew R. Zullo |
| author_sort | Melissa R. Riester |
| collection | DOAJ |
| description |
Abstract
Objective:
Assess the association between clinicians who primarily practice in nursing homes (NHs) and 14-day resident outcomes following initial antibiotic dispensing for pneumonia or urinary tract infection (UTI).
Design:
Retrospective cohort.
Setting:
U.S. NHs.
Participants:
NH residents aged ≥65 years who were prescribed antibiotics for pneumonia or UTI between 1 January 2016 and 30 November 2018.
Methods:
Medicare fee-for-service claims were linked to Minimum Data Set data. Clinicians who primarily practiced in NHs prescribed ≥90% of Part D dispensings to NH residents. Outcomes included death, all-cause and infection-specific hospitalization, and subsequent antibiotic dispensing. Adjusted risk ratios were estimated using inverse-probability-of-treatment-weighted (IPTW) modified Poisson regression models adjusting for 53 covariates.
Results:
The study population included 28,826 resident-years who were prescribed antibiotics for pneumonia and 106,354 resident-years who were prescribed antibiotics for UTI. Among the pneumonia group, clinicians who primarily practiced in NHs were associated with a greater risk of death (RR 1.3; 95%CLs 1.0, 1.6), lower risks of all-cause (RR 0.9; 95%CLs 0.8, 0.9) and infection-specific hospitalization (RR 0.8; 95%CLs 0.7, 0.9), and similar risk of subsequent antibiotic dispensing (RR 1.0; 95%CLs 1.0, 1.1) after IPTW. No meaningful associations were observed between clinicians who primarily practiced in NHs and outcomes among the UTI group.
Conclusions:
Clinicians who primarily practiced in NHs were associated with a lower risk of hospitalization but greater risk of mortality for NH residents with pneumonia. Further examination is needed to better understand drivers of differences in infection-related outcomes based on clinicians’ training and primary practice setting.
|
| first_indexed | 2024-03-08T13:21:27Z |
| format | Article |
| id | doaj.art-32a5d4e957674f158e8b75595876e735 |
| institution | Directory Open Access Journal |
| issn | 2732-494X |
| language | English |
| last_indexed | 2024-03-08T13:21:27Z |
| publishDate | 2023-01-01 |
| publisher | Cambridge University Press |
| record_format | Article |
| series | Antimicrobial Stewardship & Healthcare Epidemiology |
| spelling | doaj.art-32a5d4e957674f158e8b75595876e7352024-01-18T03:46:29ZengCambridge University PressAntimicrobial Stewardship & Healthcare Epidemiology2732-494X2023-01-01310.1017/ash.2023.527Clinicians who primarily practice in nursing homes and outcomes among residents with urinary tract infection or pneumoniaMelissa R. Riester0https://orcid.org/0000-0003-2196-0134Cody M. Douglas1Joe B.B. Silva2https://orcid.org/0000-0002-8162-6114Rupak Datta3Andrew R. Zullo4https://orcid.org/0000-0003-1673-4570Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA Center for Gerontology and Healthcare Research, Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, RI, USACenter for Gerontology and Healthcare Research, Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, RI, USACenter for Gerontology and Healthcare Research, Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, RI, USAVeterans Affairs Connecticut Healthcare System, West Haven, CT, USA Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USADepartment of Epidemiology, Brown University School of Public Health, Providence, RI, USA Center for Gerontology and Healthcare Research, Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, RI, USA Center of Innovation in Long-Term Services and Supports, Providence Veterans Affairs Medical Center, Providence, RI, USA Abstract Objective: Assess the association between clinicians who primarily practice in nursing homes (NHs) and 14-day resident outcomes following initial antibiotic dispensing for pneumonia or urinary tract infection (UTI). Design: Retrospective cohort. Setting: U.S. NHs. Participants: NH residents aged ≥65 years who were prescribed antibiotics for pneumonia or UTI between 1 January 2016 and 30 November 2018. Methods: Medicare fee-for-service claims were linked to Minimum Data Set data. Clinicians who primarily practiced in NHs prescribed ≥90% of Part D dispensings to NH residents. Outcomes included death, all-cause and infection-specific hospitalization, and subsequent antibiotic dispensing. Adjusted risk ratios were estimated using inverse-probability-of-treatment-weighted (IPTW) modified Poisson regression models adjusting for 53 covariates. Results: The study population included 28,826 resident-years who were prescribed antibiotics for pneumonia and 106,354 resident-years who were prescribed antibiotics for UTI. Among the pneumonia group, clinicians who primarily practiced in NHs were associated with a greater risk of death (RR 1.3; 95%CLs 1.0, 1.6), lower risks of all-cause (RR 0.9; 95%CLs 0.8, 0.9) and infection-specific hospitalization (RR 0.8; 95%CLs 0.7, 0.9), and similar risk of subsequent antibiotic dispensing (RR 1.0; 95%CLs 1.0, 1.1) after IPTW. No meaningful associations were observed between clinicians who primarily practiced in NHs and outcomes among the UTI group. Conclusions: Clinicians who primarily practiced in NHs were associated with a lower risk of hospitalization but greater risk of mortality for NH residents with pneumonia. Further examination is needed to better understand drivers of differences in infection-related outcomes based on clinicians’ training and primary practice setting. https://www.cambridge.org/core/product/identifier/S2732494X23005272/type/journal_article |
| spellingShingle | Melissa R. Riester Cody M. Douglas Joe B.B. Silva Rupak Datta Andrew R. Zullo Clinicians who primarily practice in nursing homes and outcomes among residents with urinary tract infection or pneumonia Antimicrobial Stewardship & Healthcare Epidemiology |
| title | Clinicians who primarily practice in nursing homes and outcomes among residents with urinary tract infection or pneumonia |
| title_full | Clinicians who primarily practice in nursing homes and outcomes among residents with urinary tract infection or pneumonia |
| title_fullStr | Clinicians who primarily practice in nursing homes and outcomes among residents with urinary tract infection or pneumonia |
| title_full_unstemmed | Clinicians who primarily practice in nursing homes and outcomes among residents with urinary tract infection or pneumonia |
| title_short | Clinicians who primarily practice in nursing homes and outcomes among residents with urinary tract infection or pneumonia |
| title_sort | clinicians who primarily practice in nursing homes and outcomes among residents with urinary tract infection or pneumonia |
| url | https://www.cambridge.org/core/product/identifier/S2732494X23005272/type/journal_article |
| work_keys_str_mv | AT melissarriester clinicianswhoprimarilypracticeinnursinghomesandoutcomesamongresidentswithurinarytractinfectionorpneumonia AT codymdouglas clinicianswhoprimarilypracticeinnursinghomesandoutcomesamongresidentswithurinarytractinfectionorpneumonia AT joebbsilva clinicianswhoprimarilypracticeinnursinghomesandoutcomesamongresidentswithurinarytractinfectionorpneumonia AT rupakdatta clinicianswhoprimarilypracticeinnursinghomesandoutcomesamongresidentswithurinarytractinfectionorpneumonia AT andrewrzullo clinicianswhoprimarilypracticeinnursinghomesandoutcomesamongresidentswithurinarytractinfectionorpneumonia |