Clinicians who primarily practice in nursing homes and outcomes among residents with urinary tract infection or pneumonia

Melissa R Riester; Cody M Douglas; Joe B B Silva; Rupak Datta; Andrew R Zullo

doi:10.1017/ash.2023.527

Clinicians who primarily practice in nursing homes and outcomes among residents with urinary tract infection or pneumonia

Antimicrob Steward Healthc Epidemiol. 2023 Dec 6;3(1):e253. doi: 10.1017/ash.2023.527. eCollection 2024.

Authors

Melissa R Riester^{1

2}, Cody M Douglas², Joe B B Silva², Rupak Datta^{3

4}, Andrew R Zullo^{1

2

5}

Affiliations

¹ Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA.
² Center for Gerontology and Healthcare Research, Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, RI, USA.
³ Veterans Affairs Connecticut Healthcare System, West Haven, CT, USA.
⁴ Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA.
⁵ Center of Innovation in Long-Term Services and Supports, Providence Veterans Affairs Medical Center, Providence, RI, USA.

Abstract

Objective: Assess the association between clinicians who primarily practice in nursing homes (NHs) and 14-day resident outcomes following initial antibiotic dispensing for pneumonia or urinary tract infection (UTI).

Design: Retrospective cohort.

Setting: U.S. NHs.

Participants: NH residents aged ≥65 years who were prescribed antibiotics for pneumonia or UTI between 1 January 2016 and 30 November 2018.

Methods: Medicare fee-for-service claims were linked to Minimum Data Set data. Clinicians who primarily practiced in NHs prescribed ≥90% of Part D dispensings to NH residents. Outcomes included death, all-cause and infection-specific hospitalization, and subsequent antibiotic dispensing. Adjusted risk ratios were estimated using inverse-probability-of-treatment-weighted (IPTW) modified Poisson regression models adjusting for 53 covariates.

Results: The study population included 28,826 resident-years who were prescribed antibiotics for pneumonia and 106,354 resident-years who were prescribed antibiotics for UTI. Among the pneumonia group, clinicians who primarily practiced in NHs were associated with a greater risk of death (RR 1.3; 95%CLs 1.0, 1.6), lower risks of all-cause (RR 0.9; 95%CLs 0.8, 0.9) and infection-specific hospitalization (RR 0.8; 95%CLs 0.7, 0.9), and similar risk of subsequent antibiotic dispensing (RR 1.0; 95%CLs 1.0, 1.1) after IPTW. No meaningful associations were observed between clinicians who primarily practiced in NHs and outcomes among the UTI group.

Conclusions: Clinicians who primarily practiced in NHs were associated with a lower risk of hospitalization but greater risk of mortality for NH residents with pneumonia. Further examination is needed to better understand drivers of differences in infection-related outcomes based on clinicians' training and primary practice setting.