Development of the invasive candidiasis discharge [I Can discharge] model: a mixed methods analysis

Jinhee Jo, Truc T. Tran, Nicholas D. Beyda, Debora Simmons, Joshua A. Hendrickson, Masaad Saeed Almutairi, Faris S. Alnezary, Anne J. Gonzales-Luna, Edward J. Septimus, Kevin W. Garey

Research output: Contribution to journalArticlepeer-review

Abstract

Patients with invasive candidiasis (IC) have complex medical and infectious disease problems that often require continued care after discharge. This study aimed to assess echinocandin use at hospital discharge and develop a transition of care (TOC) model to facilitate discharge for patients with IC. This was a mixed method study design that used epidemiologic assessment to better understand echinocandin use at hospital discharge TOC. Using grounded theory methodology focused on patients given echinocandins during their last day of hospitalization, a TOC model for patients with IC, the invasive candidiasis [I Can] discharge model was developed to better understand discharge barriers. A total of 33% (1405/4211) echinocandin courses were continued until the last day of hospitalization. Of 536 patients chosen for in-depth review, 220 (41%) were discharged home, 109 (20%) were transferred, and 207 (39%) died prior to discharge. Almost half (46%, 151/329) of patients discharged alive received outpatient echinocandin therapy. Independent predictors for outpatient echinocandin use were osteomyelitis (OR, 4.1; 95% CI, 1.1–15.7; p = 0.04), other deep-seated infection (OR, 4.4; 95% CI, 1.7–12.0; p = 0.003), and non-home discharge location (OR, 3.9, 95% CI, 2.0–7.7; p < 0.001). The I Can discharge model was developed encompassing four distinct themes which was used to identify potential barriers to discharge. Significant echinocadin use occurs at hospital discharge TOC. The I Can discharge model may help clinical, policy, and research decision-making processes to facilitate smoother and earlier hospital discharges.

Original languageEnglish (US)
Pages (from-to)1207-1213
Number of pages7
JournalEuropean Journal of Clinical Microbiology and Infectious Diseases
Volume41
Issue number10
DOIs
StatePublished - Oct 2022

Keywords

  • Candida
  • Candidemia
  • Echinocandin
  • Mixed methods study design
  • Rezafungin
  • Transitions of care

ASJC Scopus subject areas

  • Microbiology (medical)
  • Infectious Diseases

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