Infectious diseases consultation: Impact on outcomes for hospitalized patients and results of a preliminary study

In the absence of detailed and specific data on outcomes, specialists are thought to contribute excessively to the cost of care. Infectious diseases physicians are at further risk of heavy utilization of medical resources because their patients often are those with serious complications or expensive underlying diseases (e.g., AIDS). By using readily available information in a sophisticated computer database, we examined the crude economic impact of an inpatient infectious diseases consultation and identified important matching variables for more refined analysis, The study was performed at LDS Hospital (Salt Lake City), a tertiary care facility with four full-time infectious diseases physicians. A total of 496 cases (patients who were seen by an infectious diseases consultant) were matched with 3,117 controls (patients who were not seen by an infectious diseases consultant). Matching was performed on the basis of age, sex, exact discharge diagnosis-related group, minimum length of hospital stay equal to the interval from admission to consultation for cases, and measures of the severity of illness (nursing acuity score and the number of secondary diagnoses). Cases had longer lengths of hospital stays, longer intensive we unit lengths of stays, and higher antibiotic costs than did matched controls, and if the consultation occurred in the last one-third of hospitalization, cases had shorter lengths of hospital stay and lower antibiotic costs than did controls.