Discharge Decisions: The association between antibiotic strategies and subsequent healthcare utilization in Medicaid-enrolled people who inject drugs with infective endocarditis

The opioid epidemic has precipitated a surge in infective endocarditis (IE) among persons who inject drugs (PWID), which is often associated with poor long-term outcomes due to suboptimal treatment and ongoing infectious risk. Current treatment strategies, usually prolonged hospital stays for intravenous (IV) antibiotic therapy, often fail to accommodate the unique socioeconomic and clinical challenges faced by PWID, leading to high rates of patient-directed discharge (PDD) and suboptimal care continuity.

Recent studies and modeling projections have suggested that early transition to oral antibiotics can be cost-saving and efficacious in this population. This pilot study will use Medicaid claims data to explore the application of various antibiotic treatment strategies in PWID with IE, with a focus on the impact of these strategies on post-discharge healthcare utilization and mortality.

Fiona Gispen is a third-year infectious diseases fellow at New York-Presbyterian/Weill Cornell Medical Center. Originally from Mississippi, she attended Stanford University where she competed on the varsity swim team and received her undergraduate degree in human biology and master’s degree in management science and engineering. She earned her medical degree at Johns Hopkins University School of Medicine, received psychiatry and internal medicine residency training at Massachusetts General Hospital, and became a hospital medicine doctor at Vanderbilt. As a hospitalist, she found herself interested in working with patients with substance use disorders and related infections and soon matched at the infectious diseases fellowship at Weill Cornell Medicine to focus on the treatment of this population. In addition to her CHERISH pilot study, Gispen is working on a quality improvement project that connects hospitalized patients with hepatitis C to immediate treatment and low-barrier outpatient care. She plans to maintain her clinical practice in HIV primary care while conducting research to provide optimal care for people who use drugs. She’s also a yoga instructor, an aerial silks performer, and a pianist.