title: The value of specialist care-infectious disease specialist referrals-why and for whom? A retrospective cohort study in a French tertiary hospital.
abstract: This study evaluated the impact of infectious disease (ID) specialist referrals on outcomes in a tertiary hospital in France. This study tackled methodological constraints (selection bias, endogeneity) using instrumental variables (IV) methods in order to obtain a quasi-experimental design. In addition, we investigated whether certain characteristics of patients have a bearing on the impact of the intervention. We used the payments database and ID department files to obtain data for adults admitted with an ID diagnosis in the North Hospital, Marseille from 2012 to 2014. Comparable cohorts were obtained using coarsened exact matching and analysed using IV models. Mortality, readmissions, cost (payer perspective) and length of stay (LoS) were analysed. We recorded 15,393 (85.97%) stays, of which 2,159 (14.03%) benefited from IDP consultations. The intervention was seen to significantly lower the risk of inpatient mortality (marginal effect (M.E) = -19.06%) and cost of stay (average treatment effect (ATE) = - €5,573.39). The intervention group was seen to have a longer LoS (ATE = +4.95 days). The intervention conferred a higher reduction in mortality and cost for stays that experienced ICU care (mortality: odds ratio (OR) =0.09, M.E cost = -8,328.84 €) or had a higher severity of illness (mortality: OR=0.35, M.E cost = -1,331.92 €) and for patients aged between 50 and 65 years (mortality: OR=0.28, M.E cost = -874.78 €). This study shows that ID referrals are associated with lower risk of inpatient mortality and cost of stay, especially when targeted to certain subgroups.
authors.affiliation: SESSTIM, UMR 912 INSERM, Aix-Marseille University (Aix-Marseille School of Economics), Marseille, France. manoj.sasikumar@inserm.fr.
authors.forename: M
authors.identifier: http://orcid.org/0000-0001-7681-7146
authors.initials: M
authors.lastname: Sasikumar
authors.affiliation: SESSTIM, UMR 912 INSERM-IRD, Aix-Marseille Université, Marseille, France.
authors.forename: S
authors.initials: S
authors.lastname: Boyer
authors.affiliation: Service d'Information Médicale, APHM CHU Nord Marseille, Marseille, France.
authors.forename: A
authors.initials: A
authors.lastname: Remacle-Bonnet
authors.affiliation: CNRS & EHESS, Aix-Marseille University (Aix-Marseille School of Economics), Marseille, France.
authors.forename: B
authors.initials: B
authors.lastname: Ventelou
authors.affiliation: IHU Méditerranée Infection; URMITE; UM63; CNRS 7278; IRD 198; Inserm 1095, Aix Marseille Université, Marseille, France.
authors.forename: P
authors.initials: P
authors.lastname: Brouqui
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003141:Communicable Diseases / Q000175:diagnosis* / Q000188:drug therapy*; D005260:Female; D005602:France; D017048:Health Care Costs; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D010359:Patient Readmission; D012017:Referral and Consultation; D012189:Retrospective Studies; D013038:Specialization; D016019:Survival Analysis; D062606:Tertiary Care Centers