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- Title
Physician Financial Incentives for Use of Outpatient Intravenous Antimicrobial Therapy: An Interrupted Time Series Analysis.
- Authors
Staples, John A; Ho, Meghan; Ferris, Dwight; Liu, Guiping; Brubacher, Jeffrey R; Khan, Mayesha; Daly-Grafstein, Daniel; Tran, Karen C; Sutherland, Jason M
- Abstract
Background In 2011, policymakers in British Columbia introduced a fee-for-service payment to incentivize infectious diseases physicians to supervise outpatient parenteral antimicrobial therapy (OPAT). Whether this policy increased use of OPAT remains uncertain. Methods We conducted a retrospective cohort study using population-based administrative data over a 14-year period (2004–2018). We focused on infections that required intravenous antimicrobials for ≥10 days (eg, osteomyelitis, joint infection, endocarditis) and used the monthly proportion of index hospitalizations with a length of stay shorter than the guideline-recommended "usual duration of intravenous antimicrobials" (LOS < UDIVA) as a surrogate for population-level OPAT use. We used interrupted time series analysis to determine whether policy introduction increased the proportion of hospitalizations with LOS < UDIVA. Results We identified 18 513 eligible hospitalizations. In the pre-policy period, 82.3% of hospitalizations exhibited LOS < UDIVA. Introduction of the incentive was not associated with a change in the proportion of hospitalizations with LOS < UDIVA, suggesting that the policy intervention did not increase OPAT use (step change, −0.06%; 95% confidence interval [CI], −2.69% to 2.58%; P =.97 and slope change, −0.001% per month; 95% CI, −.056% to.055%; P =.98). Conclusions The introduction of a financial incentive for physicians did not appear to increase OPAT use. Policymakers should consider modifying the incentive design or addressing organizational barriers to expanded OPAT use.
- Subjects
FEE for service (Medical fees); HEALTH policy; LENGTH of stay in hospitals; OUTPATIENT medical care; INTRAVENOUS therapy; COMMUNICABLE diseases; CONFIDENCE intervals; RETROSPECTIVE studies; TIME series analysis; HOSPITAL care; DESCRIPTIVE statistics; RESEARCH funding; POLICY sciences; ODDS ratio; PSYCHOLOGY of physicians; ANTIBIOTICS; LONGITUDINAL method
- Publication
Clinical Infectious Diseases, 2023, Vol 76, Issue 12, p2098
- ISSN
1058-4838
- Publication type
Article
- DOI
10.1093/cid/ciad082