Team-based, hybrid, or standard of care? Organizational models of tuberculosis care on tuberculosis outcomes in eleven Italian hospital.
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Guido Giacomo, Di Gennaro Francesco, Cavallin Francesco, Pisaturo Mariantonietta, Onorato Lorenzo, Zimmerhofer Federica, Bruno Giuseppe, Fasano Massimo, Di Gregorio Stefano, Pontarelli Agostina, Iacovazzi Tiziana, Di Bari Virginia, Ferrante Marika, Manco Cesare Giorgia, Frallonardo Luisa, Panico Gianfranco, Libertone Raffaella, Monari Caterina, Musto Alessia, Serapide Francesca, Niglio Mariangela, Rotundo Salvatore, De Gregorio Federica, Cibelli Marinella, Alessio Loredana, De Iaco Giuseppina, Lattanzio Rossana, Ronga Luigi, Brindicci Gaetano, Giliberti Vincenzo, Santoro Carmen Rita, Gualano Gina, Minniti Salvatore, Buccoliero Giovanni Battista, Lo Caputo Sergio, Carbonara Sergio, Cascio Antonio, Russo Alessandro, Parrella Roberto, Palmieri Fabrizio, Saracino Annalisa, Coppola Nicola
Аннотация
METHODS: We conducted a multicentre study including all TB patients diagnosed between 2021 and 2024 in 11 hospitals in five regions. Centres were categorized into three care models: (i) TB team (structured care with trained staff, dedicated outpatient clinics, and proactive follow-up); (ii) hybrid centre (HC); and (iii) standard-of-care (SOC). Primary outcomes included hospital length of stay, incidence and severity of adverse events, treatment completion, and LTFU. Mixed-effect regression models adjusted for confounders.
RESULTS: Of 717 pansusceptible and monoresistant TB patients, 375 (52.3%) were treated in TB team centres, 175 (24.4%) in HC, and 167 (23.3%) in SOC centres. Treatment completion was higher in TB team (327/375, 87.2%) vs. HC (116/162, 71.6%) and SOC centres (89/158, 56.3%) (p < 0.0001), whereas LTFU was lowest in TB team (35/375, 9.3%) vs. HC (44/162 27.2%) and SOC (63/158, 39.9%) (p < 0.0001). Hospital stay was shorter in the TB team (median 26 days, interquartile range (IQR), 15-55) and HC (35 days, IQR, 22-62) compared with SOC (50 days, IQR, 22-82) (p < 0.0001). The occurrence of adverse events was similar (p 0.54), with lower severity in the TB team and HC. Adjusted analyses confirmed lower risk of incomplete treatment (OR, 0.10; 95% CI, 0.03-0.30), LTFU (OR, 0.09; 95% CI, 0.04-0.23), and severe adverse events (OR, 0.40; 95% CI, 0.17-0.95) in the TB team vs. SOC.
DISCUSSION: The TB-dedicated care model was associated with improved outcomes, fewer severe adverse events, higher treatment completion rates, and lower LTFU. Although hybrid models conferred intermediate benefit, implementation of TB care ensured consistent gains. These findings support scaling up TB team-based models to strengthen TB control and align with elimination targets.