title: Outcomes, impact on management, and costs of fungal eye disease consults in a tertiary care setting.
abstract: OBJECTIVE
  To determine the frequency of clinical management changes resulting from inpatient ophthalmic consultations for fungemia and the associated costs.
  
  
  METHODS
  Retrospective case series.
  
  
  METHODS
  Three hundred forty-eight inpatients at a tertiary care center between 2008 and 2012 with positive fungal blood culture results, 238 of whom underwent an ophthalmologic consultation.
  
  
  METHODS
  Inpatient charts of all fungemic patients were reviewed. Costs were standardized to the year 2014. The Student t test was used for all continuous variables and the Pearson chi-square test was used for categorical variables.
  
  
  METHODS
  Prevalence of ocular involvement, rate of change in clinical management, mortality rate of fungemic patients, and costs of ophthalmic consultation.
  
  
  RESULTS
  Twenty-two (9.2%) of 238 consulted patients with fungemia had ocular involvement. Twenty patients had chorioretinitis and 2 had endophthalmitis. Only 9 patients (3.7%) had a change in management because of the ophthalmic consultation. One patient underwent bilateral intravitreal injections. Thirty percent of consulted patients died before discharge or were discharged to hospice. The total cost of new consults was $36 927.54 ($204.19/initial level 5 visit and $138.63/initial level 4). The cost of follow-up visits was $13 655.44 ($104.24/visit). On average, 26.4 patients were evaluated to find 1 patient needing change in management, with an average cost of $5620.33 per change in 1 patient's management.
  
  
  CONCLUSIONS
  Clinical management changes resulting from ophthalmic consultation in fungemic patients were uncommon. Associated costs were high for these consults in a patient population with a high mortality rate. Together, these data suggest that the usefulness of routine ophthalmic consultations for all fungemic patients is likely to be low.
authors.affiliation: Scheie Eye Institute, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Devon H
authors.initials: DH
authors.lastname: Ghodasra
authors.affiliation: Scheie Eye Institute, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Kian
authors.initials: K
authors.lastname: Eftekhari
authors.affiliation: Associated Retinal Consultants, PC, Royal Oak, Michigan; Department of Ophthalmology, William Beaumont Hospital, Royal Oak, Michigan.
authors.forename: Ankoor R
authors.initials: AR
authors.lastname: Shah
authors.affiliation: Scheie Eye Institute, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Center for Clinical Epidemiology and Biostatistics, Department of Biostatistics & Epidemiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania. Electronic address: Brian.VanderBeek@uphs.upenn.edu.
authors.forename: Brian L
authors.initials: BL
authors.lastname: VanderBeek
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002825:Chorioretinitis / Q000191:economics / Q000453:epidemiology / Q000628:therapy*; D003941:Diagnostic Techniques, Ophthalmological / Q000191:economics; D009877:Endophthalmitis / Q000191:economics / Q000453:epidemiology / Q000628:therapy*; D015821:Eye Infections, Fungal / Q000191:economics* / Q000453:epidemiology / Q000382:microbiology; D005260:Female; D017048:Health Care Costs; D017721:Hospital Costs; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D010414:Pennsylvania / Q000453:epidemiology; D012017:Referral and Consultation / Q000191:economics; D012189:Retrospective Studies; D055815:Young Adult
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