Healthcare-Associated Infection and Hospital Readmission
Healthcare-Associated Infection and Hospital Readmission
Objective. Hospital readmissions are a current target of initiatives to reduce healthcare costs. This study quantified the association between having a clinical culture positive for 1 of 3 prevalent hospital-associated organisms and time to hospital readmission.
Retrospective cohort study.
Design. Patients Adults admitted to an academic, tertiary care referraland setting. center from January 1, 2001, through December 31, 2008.
The primary exposure of interest was a clinical culture positive for methicillin-resistant.
Methods.Staphylococcus aureus (MRSA), vancomycin-resistant enterococci (VRE), or Clostridium difficile obtained more than 48 hours after hospital admission during the index hospital stay. The primary outcome of interest was time to readmission to the index facility. Multivariable Cox proportional hazards models were used to model the adjusted association between positive clinical culture result and time to readmission and to calculate hazard ratios (HRs) and 95% confidence intervals (CIs).
Results. Among 136,513 index admissions, the prevalence of hospital-associated positive clinical culture result for 1 of the 3 organisms of interest was 3%, and 35% of patients were readmitted to the index facility within 1 year after discharge. Patients with a positive clinical culture obtained more than 48 hours after hospital admission had an increased hazard of readmission (HR, 1.40; 95% CI, 1.33–1.46) after adjusting for age, sex, index admission length of stay, intensive care unit stay, Charlson comorbidity index, and year of hospital admission.
Conclusions. Patients with healthcare-associated infections may be at increased risk of hospital readmission. These findings may be used to impact health outcomes after discharge from the hospital and to encourage better infection prevention efforts.
Hospital readmission has been identified as a key quality indicator and target for reducing healthcare spending. For example, approximately 20% of Medicare beneficiaries in 2004 were readmitted within 30 days after hospital discharge at a cost of approximately $17.4 billion. Similarly, healthcare-associated infections are associated with higher healthcare costs and may act as a surrogate for hospital quality of care. Healthcare-associated infections are also associated with considerable morbidity and mortality among infected patients and continue to increase in incidence despite laborious and costly infection prevention efforts.
Although much attention has been directed toward hospital readmissions and healthcare-associated infections as potentially preventable conditions and targets to reduce healthcare spending, to our knowledge, no studies have directly assessed the association between the two. In this study, we aimed to investigate the association between hospital-associated infection and time to hospital readmission. A positive association would provide additional incentives for infection prevention and could aid in targeting patients for more intensive hospital discharge planning. We hypothesized that a clinical culture positive for 1 of 3 prevalent healthcare-associated pathogens (methicillin-resistant Staphylococcus aureus [MRSA], vancomycin-resistant enterococci [VRE], or Clostridium difficile) that was obtained more than 48 hours after hospital admission would be associated with a shorter time to hospital readmission.
Abstract and Introduction
Abstract
Objective. Hospital readmissions are a current target of initiatives to reduce healthcare costs. This study quantified the association between having a clinical culture positive for 1 of 3 prevalent hospital-associated organisms and time to hospital readmission.
Retrospective cohort study.
Design. Patients Adults admitted to an academic, tertiary care referraland setting. center from January 1, 2001, through December 31, 2008.
The primary exposure of interest was a clinical culture positive for methicillin-resistant.
Methods.Staphylococcus aureus (MRSA), vancomycin-resistant enterococci (VRE), or Clostridium difficile obtained more than 48 hours after hospital admission during the index hospital stay. The primary outcome of interest was time to readmission to the index facility. Multivariable Cox proportional hazards models were used to model the adjusted association between positive clinical culture result and time to readmission and to calculate hazard ratios (HRs) and 95% confidence intervals (CIs).
Results. Among 136,513 index admissions, the prevalence of hospital-associated positive clinical culture result for 1 of the 3 organisms of interest was 3%, and 35% of patients were readmitted to the index facility within 1 year after discharge. Patients with a positive clinical culture obtained more than 48 hours after hospital admission had an increased hazard of readmission (HR, 1.40; 95% CI, 1.33–1.46) after adjusting for age, sex, index admission length of stay, intensive care unit stay, Charlson comorbidity index, and year of hospital admission.
Conclusions. Patients with healthcare-associated infections may be at increased risk of hospital readmission. These findings may be used to impact health outcomes after discharge from the hospital and to encourage better infection prevention efforts.
Introduction
Hospital readmission has been identified as a key quality indicator and target for reducing healthcare spending. For example, approximately 20% of Medicare beneficiaries in 2004 were readmitted within 30 days after hospital discharge at a cost of approximately $17.4 billion. Similarly, healthcare-associated infections are associated with higher healthcare costs and may act as a surrogate for hospital quality of care. Healthcare-associated infections are also associated with considerable morbidity and mortality among infected patients and continue to increase in incidence despite laborious and costly infection prevention efforts.
Although much attention has been directed toward hospital readmissions and healthcare-associated infections as potentially preventable conditions and targets to reduce healthcare spending, to our knowledge, no studies have directly assessed the association between the two. In this study, we aimed to investigate the association between hospital-associated infection and time to hospital readmission. A positive association would provide additional incentives for infection prevention and could aid in targeting patients for more intensive hospital discharge planning. We hypothesized that a clinical culture positive for 1 of 3 prevalent healthcare-associated pathogens (methicillin-resistant Staphylococcus aureus [MRSA], vancomycin-resistant enterococci [VRE], or Clostridium difficile) that was obtained more than 48 hours after hospital admission would be associated with a shorter time to hospital readmission.
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