Improved survival with initial MRSA therapy in high-risk community-onset pneumonia patients : application of a MRSA risk score

textCommunity-onset (CO) methicillin-resistant Staphylococcus aureus (MRSA) pneumonia is an evolving problem, and there is a great need for a reliable method to assess MRSA risk at hospital admission. A new MRSA prediction score classifies CO-pneumonia patients into low, medium, and high-risk groups based on objective criteria available at baseline. Our objective was to assess the effect of initial MRSA therapy on mortality in these three risk groups. We conducted a retrospective cohort study using data from the Veterans Health Administration. Patients were included if they were hospitalized with pneumonia and received antibiotics within the first 48 hours of admission. They were stratified into MRSA therapy and no MRSA therapy treatment arms based on antibiotics received in the first 48 hours. MRSA risk groups were analyzed separately. The primary outcome was 30-day patient mortality. Multivariable logistic regression was used to adjust for potential confounders. A total of 80,330 patients met inclusion criteria, of which 36% received MRSA therapy and 64% did not receive MRSA therapy. The majority of patients were classified as either low (51%) or medium (47%) risk, with only 2% classified as high-risk. In the high-risk group, unadjusted 30-day mortality was lower among patients who received initial MRSA therapy (40% versus 58%; p<0.0001). Likewise, multivariable logistic regression analysis also demonstrated that initial MRSA therapy was associated with a lower 30-day mortality in the high-risk group (adjusted odds ratio 0.57; 95% confidence interval 0.42-0.77). There was no benefit of initial MRSA therapy in the low or medium-risk groups. This study demonstrated improved survival with initial MRSA therapy in high-risk CO-pneumonia patients. The MRSA risk score should not replace clinical judgment, but it might be a useful tool to spare MRSA therapy for only those patients who are most likely to benefit.Pharmaceutical Science

Improved survival with initial MRSA therapy in high-risk community-onset pneumonia patients : application of a MRSA risk score

textCommunity-onset (CO) methicillin-resistant Staphylococcus aureus (MRSA) pneumonia is an evolving problem, and there is a great need for a reliable method to assess MRSA risk at hospital admission. A new MRSA prediction score classifies CO-pneumonia patients into low, medium, and high-risk groups based on objective criteria available at baseline. Our objective was to assess the effect of initial MRSA therapy on mortality in these three risk groups. We conducted a retrospective cohort study using data from the Veterans Health Administration. Patients were included if they were hospitalized with pneumonia and received antibiotics within the first 48 hours of admission. They were stratified into MRSA therapy and no MRSA therapy treatment arms based on antibiotics received in the first 48 hours. MRSA risk groups were analyzed separately. The primary outcome was 30-day patient mortality. Multivariable logistic regression was used to adjust for potential confounders. A total of 80,330 patients met inclusion criteria, of which 36% received MRSA therapy and 64% did not receive MRSA therapy. The majority of patients were classified as either low (51%) or medium (47%) risk, with only 2% classified as high-risk. In the high-risk group, unadjusted 30-day mortality was lower among patients who received initial MRSA therapy (40% versus 58%; p<0.0001). Likewise, multivariable logistic regression analysis also demonstrated that initial MRSA therapy was associated with a lower 30-day mortality in the high-risk group (adjusted odds ratio 0.57; 95% confidence interval 0.42-0.77). There was no benefit of initial MRSA therapy in the low or medium-risk groups. This study demonstrated improved survival with initial MRSA therapy in high-risk CO-pneumonia patients. The MRSA risk score should not replace clinical judgment, but it might be a useful tool to spare MRSA therapy for only those patients who are most likely to benefit.Pharmaceutical Science

Western Baptist Hospital: Problem-Solving With Pneumonia Care Performance Improvement Teams

Describes successful strategies for strengthening pneumonia care, including multidisciplinary performance improvement teams, process improvements built into staff routines, peer collaboratives, standard order sets, and feedback through concurrent review

Association of Electronic Health Records with Methicillin-Resistant Staphylococcus aureus Infection in a National Sample

This study examined the relationship between advanced electronic health record (EHR) use in hospitals and rates of Methicillin-resistant Staphylococcus aureus (MRSA) infection in an inpatient setting. National Inpatient Sample (NIS) and Health Information Management Systems Society (HIMSS) Annual Survey are combined in the retrospective, cross-sectional analysis. A twenty percent simple random sample of the combined 2009 NIS and HIMSS datasets included a total of 1,032,905 patient cases of MRSA in 550 hospitals. Results of the propensity-adjusted logistic regression model revealed a statistically significant association between advanced EHR and MRSA, with patient cases from an advanced EHR being less likely to report a MRSA diagnosis code

Effectiveness and Safety of COPD Maintenance Therapy with Tiotropium/Olodaterol versus LABA/ICS in a US Claims Database

Malaltia pulmonar obstructiva crònica; Corticosteroides; OlodaterolEnfermedad pulmonar obstructiva crónica; Corticosteroides; OlodaterolChronic obstructive pulmonary disease; Corticosteroids; OlodaterolIntroduction In patients with chronic obstructive pulmonary disease (COPD), treatment with long-acting muscarinic antagonist (LAMA)/long-acting β2-agonist (LABA) combination therapy significantly improves lung function versus LABA/inhaled corticosteroid (ICS). To investigate whether LAMA/LABA could provide better clinical outcomes than LABA/ICS, this non-interventional database study assessed the risk of COPD exacerbations, pneumonia, and escalation to triple therapy in patients with COPD initiating maintenance therapy with tiotropium/olodaterol versus any LABA/ICS combination. Methods Administrative healthcare claims and laboratory results data from the US HealthCore Integrated Research DatabaseSM were evaluated for patients with COPD initiating tiotropium/olodaterol versus LABA/ICS treatment (January 2013–March 2019). Patients were aged at least 40 years with a diagnosis of COPD (but not asthma) at cohort entry. A Cox proportional hazard regression model was used (as-treated analysis) to assess risk of COPD exacerbation, community-acquired pneumonia, and escalation to triple therapy, both individually and as a combined risk of any one of these events. Potential imbalance of confounding factors between cohorts was handled using fine stratification, reweighting, and trimming by exposure propensity score (high-dimensional); subgroup analyses were conducted on the basis of blood eosinophil levels and exacerbation history. Results The total population consisted of 61,985 patients (tiotropium/olodaterol n = 2684; LABA/ICS n = 59,301); after reweighting, the total was 42,953 patients (tiotropium/olodaterol n = 2600; LABA/ICS n = 40,353; mean age 65 years; female 54.5%). Patients treated with tiotropium/olodaterol versus LABA/ICS experienced a reduction in the risk of COPD exacerbations (adjusted hazard ratio 0.76 [95% confidence interval 0.68, 0.85]), pneumonia (0.74 [0.57, 0.97]), escalation to triple therapy (0.22 [0.19, 0.26]), and any one of these events (0.45 [0.41, 0.49]); the combined risk was similar irrespective of baseline eosinophils and exacerbation history. Conclusions In patients with COPD, tiotropium/olodaterol was associated with a lower risk of COPD exacerbations, pneumonia, and escalation to triple therapy versus LABA/ICS, both individually and in combination; the combined risk was reduced irrespective of baseline eosinophils or exacerbation history.Support for this project and the journal’s Open Access Fee were funded by Boehringer Ingelheim International GmbH. No Rapid Service Fee was received by the journal for the publication of this article

Organizing for Higher Performance: Case Studies of Organized Delivery Systems

Offers lessons learned from healthcare delivery systems promoting the attributes of an ideal model as defined by the Fund: information continuity, care coordination and transitions, system accountability, teamwork, continuous innovation, and easy access

Quality of Health Care for Medicare Beneficiaries: A Chartbook

Provides the results of a review of recently published studies and reports about the quality of health care for elderly Medicare beneficiaries. Includes examples of deficiencies and disparities in care, and some promising quality improvement initiatives

Addressing the Health Needs of an Aging America: New Opportunities for Evidence-Based Policy Solutions

This report systematically maps research findings to policy proposals intended to improve the health of the elderly. The study identified promising evidence-based policies, like those supporting prevention and care coordination, as well as areas where the research evidence is strong but policy activity is low, such as patient self-management and palliative care. Future work of the Stern Center will focus on these topics as well as long-term care financing, the health care workforce, and the role of family caregivers

Inpatient Glycemic Management: Glucose Control Relationship with Hospital Variables, Discharge Planning and Education

This dissertation study examined the relationship of glucose control with clinical outcomes, costs, discharge planning and education. Extant studies showed that hyperglycemia, in the presence or absence of a diabetes diagnosis, is prevalent in hospitalized patients. Hyperglycemia is found in one-third of all hospital admissions and is linked to poor clinical outcomes and increased healthcare costs. Furthermore, clinical evidence suggests that lack of discharge coordination associated with medical errors and readmission. This entire body of work contains three distinct sections: Two manuscripts and a grant proposal. The two manuscripts in this study were based on more current retrospective data at the time of the study. The first manuscript Inpatient glycemic management: relationship among glucose control, clinical outcomes and costs discussed the results on glucose control, clinical outcomes and costs by provider groups. The second manuscript Inpatient glycemic management: team approach in diabetes education and discharge planning discussed the outcomes of improved discharge planning and coordination with the intervention of the glycemic management team. The grant proposal Inpatient glycemic management: clinical and economic impact of changing from sliding scale insulin to basal-bolus was awarded $105,000 funding by a private pharmaceutical company. The study associated with the grant funding was a completely separate study done in collaboration with the grantor