Goto M, et al. - The relationship of evidence-based care processes in routine care for S aureus bacteremia with mortality is scrutinized in this study. Mortality related to S aureus bacteremia reduced significantly in Veterans Health Administration (VHA) hospitals, and a substantial portion of the reducing mortality may have been attributable to increased utilization of evidence-based care processes. The experience in VHA hospitals demonstrates that increasing application of these care processes may improve survival among patients with S aureus bacteremia in routine health care settings.

Methods

• For this research, they designed a retrospective observational cohort study.
• From January 1, 2003, through December 31, 2014, they examined all patients admitted to Veterans Health Administration (VHA) acute care hospitals who had a first episode of S aureus bacteremia.

Results

• Investigations included total 36,868 patients in 124 hospitals (mean [SD] age, 66.4 [12.5] years; 36,036 [97.7%] male), including 19,325 (52.4%) with infection because of methicillin-resistantS aureus and 17,543 (47.6%) with infection because of methicillin-susceptible S aureus.
• Risk-adjusted mortality reduced from 23.5% (95% CI, 23.3%-23.8%) in 2003 to 18.2% (95% CI, 17.9%-18.5%) in 2014.
• Rates of appropriate antibiotic prescribing increased from 2467 (66.4%) to 1991 (78.9%), echocardiography from 1256 (33.8%) to 1837 (72.8%), and ID consultation from 1390 (37.4%) to 1717 (68.0%).
• After adjustment for patient characteristics, cohort year, and other care processes, receipt of care processes was related to lower mortality, with adjusted odds ratios of 0.74 (95% CI, 0.68-0.79) for appropriate antibiotics, 0.73 (95% CI, 0.68-0.78) for echocardiography, and 0.61 (95% CI, 0.56-0.65) for ID consultation.
• Mortality decreased progressively as the number of care processes that a patient received increased (adjusted odds ratio for all 3 processes compared with none, 0.33; 95% CI, 0.30-0.36).
• An estimated 57.3% (95% CI, 48.4%-69.9%) of the reduce in mortality between 2003 and 2014 could be attributed to increased utilization of these evidence-based care processes.