title: Correlates and Economic and Clinical Outcomes of an Adult IV to PO Antimicrobial Conversion Program at an Academic Medical Center in Midwest United States.
abstract: The study objectives were to evaluate the correlates and outcomes of a parenteral (IV) to oral (PO) antimicrobial conversion program at a Midwest US Academic Medical Center with the hypothesis that it will be associated with reduced drug costs. Patient-level data (n = 237; sex, race, admission source, admission status, admission severity, risk of mortality [relative expected, admission], and early death) were extracted from the Clinical Data Base/Resource Manager. Medication-level, drug-encounter data (n = 317; antibiotic/dose/route/frequency/duration, conversion status, 10-day IV/PO switch-eligibility criteria) were extracted from patient's hospital medical records. Univariate analyses using chi-square or Fisher's exact test for categorical variables and Wilcoxon rank-sum test for continuous variables showed patients not converted (n = 149) versus converted (n = 88) at some point from IV to PO were more likely to be of white race and had higher risk of relative expected mortality. By applying the unit drug cost (derived from 2010 Thomson Reuters RED BOOK(TM)) and labor costs for IV/PO administration, both per dose, the overall 1-month drug cost-saving estimates in 2010 in US dollars were US$5242 from converting and US$8805 savings missed from not converting 518 and 1387 switch-eligible antibiotic doses, respectively. Despite sample-size limitations, this study demonstrated correlates and missed opportunities to convert antimicrobials from IV to PO, which warrants providers' attention.
authors.affiliation: Department of Pharmacy Practice, College of Pharmacy, University of Nebraska Medical Center, Omaha, NE, USA.
authors.forename: Rory
authors.initials: R
authors.lastname: Sallach-Ruma
authors.affiliation: Pharmacy Relations & Clinical Decision Support, The Nebraska Medical Center, Omaha, NE, USA.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Nieman
authors.affiliation: Department of Pharmacy Practice, College of Pharmacy, University of Nebraska Medical Center, Omaha, NE, USA Department of Pharmacy Practice, School of Pharmacy, University of Connecticut/Hartford Hospital, Storrs, CT, USA jsankara@uconn.edu.
authors.forename: Jayashri
authors.initials: J
authors.lastname: Sankaranarayanan
authors.affiliation: Information Technology Services, University of Nebraska Medical Center, Omaha, NE, USA.
authors.forename: Tom
authors.initials: T
authors.lastname: Reardon
mesh_terms: D000046:Academic Medical Centers; D061605:Administration, Intravenous; D000284:Administration, Oral; D000890:Anti-Infective Agents / Q000008:administration & dosage* / Q000191:economics* / Q000627:therapeutic use; D016527:Drug Costs; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015146:Midwestern United States; D016896:Treatment Outcome
chemical_list: D000890:Anti-Infective Agents
keywords: IV to PO conversion; antimicrobials; clinical outcomes; correlates; drug cost savings