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Hospital Clostridium difficile Infection Rates and Prediction of Length of Stay in Patients Without C. difficile Infection.

ABSTRACT: BACKGROUND Inpatient length of stay (LOS) has been used as a measure of hospital quality and efficiency. Patients with Clostridium difficile infections (CDI) have longer LOS. OBJECTIVE To describe the relationship between hospital CDI incidence and the LOS of patients without CDI. DESIGN Retrospective cohort analysis. METHODS We predicted average LOS for patients without CDI at both the hospital and patient level using hospital CDI incidence. We also controlled for hospital characteristics (eg, bed size) and patient characteristics (eg, comorbidities, age). SETTING Healthcare Cost and Utilization Project Nationwide Inpatient Sample, 2009-2011. PATIENTS The Nationwide Inpatient Sample includes patients from a 20% sample of all nonfederal US hospitals. RESULTS Inpatient LOS was significantly longer (P<.001) at hospitals with greater CDI incidence at both the hospital and individual level. At a hospital level, a percentage point increase in the CDI incidence rate was associated with more than an additional day's stay (between 1.19 and 1.61 days). At the individual level, controlling for all observable variables, a percentage point increase in the CDI incidence rate at their hospital was also associated with longer LOS (between 0.6 and 1.05 additional days). Hospital CDI incidence had a larger impact on LOS than many other commonly used predictors of LOS. CONCLUSION CDI rates are a predictor of LOS in patients without CDI at an individual and institutional level. CDI rates are easy to measure and report and thus may provide an important marker for hospital efficiency and/or quality.

SUBMITTER: Miller AC

PROVIDER: S-EPMC5037957 | biostudies-literature | 2016 Apr

REPOSITORIES: biostudies-literature

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Hospital Clostridium difficile Infection Rates and Prediction of Length of Stay in Patients Without C. difficile Infection.

Miller Aaron C AC Polgreen Linnea A LA Cavanaugh Joseph E JE Polgreen Philip M PM

Infection control and hospital epidemiology 20160209 4

BACKGROUND Inpatient length of stay (LOS) has been used as a measure of hospital quality and efficiency. Patients with Clostridium difficile infections (CDI) have longer LOS. OBJECTIVE To describe the relationship between hospital CDI incidence and the LOS of patients without CDI. DESIGN Retrospective cohort analysis. METHODS We predicted average LOS for patients without CDI at both the hospital and patient level using hospital CDI incidence. We also controlled for hospital characteristics (eg, ...[more]

PMID: 26858126

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Project description:BackgroundHospital length of stays (LOS) for incident of hip fracture are decreasing, but it is unknown if these changes have negative impacts on vulnerable older patient populations, like those with Alzheimer's disease (AD). We aimed to assess if persons with and without AD have different hospital LOS for hip fracture, and is the LOS associated with hospital readmissions.MethodsUtilizing register-based data for a matched cohort study nested in the Medication use and Alzheimer's disease study (MEDALZ), we collected all community-dwelling persons in Finland diagnosed with AD during 2005-2012, had incident of first hip fracture between 2005 and 2015 after AD diagnosis, and were discharged alive from an acute care hospital. Hospital LOS and hospital readmissions within 30-days and 90-days were compared between those with and without AD and risk of readmission was assessed using binary logistic regression analysis.ResultsIn this matched cohort study of 12,532 persons (mean age 84.6?years (95% CI: 84.5-84.7), 76.8% women), the median LOS in an acute care hospital was 1 day shorter for those with AD (median 4?days, IQR 3-7) than those without AD (median 5?days, IQR 3-7) (P?<?0.001). However, the AD cohort had respectively 6?days and 5?days longer median LOS in a community hospital, and total hospital stay compared to the non-AD cohort (P?<?0.001 for all comparisons). Those with AD had fewer readmissions within 30-days (10.7%) and 90-days (16.9%) compared to those without AD (13.3% 30-days and 20.7% 90-days) (P?<?0.001 for all comparisons). Both cohorts had a reduced readmission risk within 30-days when the LOS in an acute care hospital was 4-14?days, compared to a LOS less than 4?days.ConclusionsPersons with AD had shorter acute care hospital LOS, but had longer LOS in a community hospital setting compared to those without AD, which is similar to other findings when comparing total hospital LOS. These findings imply that short LOS in acute care hospitals may be associated with poor health outcomes for vulnerable older populations after hip fracture.

Dataset Information

Hospital Clostridium difficile Infection Rates and Prediction of Length of Stay in Patients Without C. difficile Infection.

Publications

Hospital Clostridium difficile Infection Rates and Prediction of Length of Stay in Patients Without C. difficile Infection.

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