The Prevalence and Incremental Costs of Healthcare Associated Infections for Individuals Admitted for Potentially Preventable Hospitalization

Since there is a limited literature base concerning individuals admitted with a potentially preventable hospitalization (PPH) who acquired a healthcare associated infection (HAI), this research identified the prevalence and costs of individuals admitted to Texas hospitals in 2011 for a PPH and acquired an HAI. Based on IOM identified associations between PPH and uninsurance, the analytic evaluation draws from theoretical models that link insurance status to outcomes such as PPH. Using the hypothesis that the cost of preventive care for the uninsured with ambulatory care sensitive conditions (ACSC) that lead to PPH would be less than the incremental cost of healthcare for HAI in individuals admitted with a PPH and acquired an HAI, I estimated costs for ACSC related preventive care, PPH, and the incremental cost of HAI. The Agency for Healthcare Research and Quality (AHRQ) Quality Indicator modules identified PPH using administrative inpatient discharge data and private insurer claims data. Adjusting for demographic, community and hospital characteristics, logistic regression analysis estimated odds ratios of PPH individuals acquiring an HAI, and generalized least squared regression estimated costs needed to address the hypothesis. I identified 1,031 individuals in the 2011 Texas inpatient discharge data with both a PPH and an HAI. 66% of the PPH with HAI population identified Medicare as their primary payer, and 7% identified Self-pay or Charity as primary payer. Most PPH individuals had lower odds of acquiring an HAI. However, individuals admitted with diabetes related lower extremity amputation demonstrated a significantly higher odds of acquiring either Clostridium difficile infection (OR: 2.9, CI_(95%) 2.16, 3.91) or ventilator associated pneumonia (OR: 1.4, CI_(95%) 0.95, 2.18). The adjusted mean cost per hospitalization for PPH was approximately $2,000 less than the general inpatient population. The estimated incremental cost of HAI for the 97 uninsured individuals in the PPH and HAI population was$2.1 million. The cost of preventive healthcare for uninsured individuals in Texas with an ACSC was estimated at $66.8 billion. Given the large proportion of insured within the PPH with HAI population, and the incremental cost of HAI quantified, I recommend additional research focusing on the Medicare population affected

Uncompensated Care Cost: A Pilot Study Using Hospitals in a Texas County

The financial ramifications of uncompensated care cost (UCC) on the healthcare industry have been difficult to quantify. With the lack of a standardized definition of uncompensated care and the need to account for the uninsured, indigent, and immigrant populations, the authors identified $190 million of UCC from Southwestern border hospitals for emergency room treatment of undocumented immigrants and$934 million of uncompensated care charges for 23 hospitals in a Texas county, which translated to $353 million of UCC. Although lawmakers passed the Medicare Prescription Drug Improvement and Modernization Act (2003) to address the growing imbalance, the shortfall of funds highlights the growing crisis and need for policy intervention

Real-World Treatment Patterns of Antiviral Prophylaxis for Cytomegalovirus Among Adult Kidney Transplant Recipients: A Linked USRDS-Medicare Database Study

Limited data exist on cytomegalovirus (CMV) antiviral treatment patterns among kidney transplant recipients (KTRs). Using United States Renal Database System registry data and Medicare claims (1 January 2011–31 December 2017), we examined CMV antiviral use in 20,601 KTRs who received their first KT from 2011 to 2016. Three-quarters of KTRs started CMV prophylaxis (86.9% of high-, 83.6% of intermediate-, and 31.7% of low-risk KTRs). Median time to prophylaxis discontinuation was 121, 90, and 90 days for high-, intermediate-, and low-risk KTRs, respectively. Factors associated with receiving CMV prophylaxis were high-risk status, diabetes, receipt of a well-functioning kidney graft, greater time on dialysis before KT, panel reactive antibodies ≥80%, and use of antithymocyte globulin, alemtuzumab, and tacrolimus. KTRs were more likely to discontinue CMV prophylaxis if they developed leukopenia/neutropenia, had liver disease, or had a deceased donor. These findings suggest that adherence to the recommended duration of CMV-prophylaxis for high and intermediate-risk patients is suboptimal, and CMV prophylaxis is overused in low-risk patients

Corrigendum: Real-World Treatment Patterns of Antiviral Prophylaxis for Cytomegalovirus Among Adult Kidney Transplant Recipients: A Linked USRDS-Medicare Database Study

Graphical Abstrac

Potentially Preventable Hospitalizations and the Burden of Healthcare-Associated Infections.

BackgroundAn estimated 4% of hospital admissions acquired healthcare-associated infections (HAIs) and accounted for $9.8 (USD) billion in direct cost during 2011. In 2010, nearly 140 000 of the 3.5 million potentially preventable hospitalizations (PPHs) may have acquired an HAI. There is a knowledge gap regarding the co-occurrence of these events.AimsTo estimate the period occurrences and likelihood of acquiring an HAI for the PPH population.MethodsRetrospective, cross-sectional study using logistic regression analysis of 2011 Texas Inpatient Discharge Public Use Data File including 2.6 million admissions from 576 acute care hospitals. Agency for Healthcare Research and Quality Prevention Quality Indicator software identified PPH, and existing administrative data identification methodologies were refined for Clostridium difficile infection, central line-associated bloodstream infection, catheter-associated urinary tract infection, and ventilator-associated pneumonia. Odds of acquiring HAIs when admitted with PPH were adjusted for demographic, health status, hospital, and community characteristics.FindingsWe identified 272 923 PPH, 14 219 HAI, and 986 admissions with PPH and HAI. Odds of acquiring an HAI for diabetic patients admitted for lower extremity amputation demonstrated significantly increased odds ratio of 2.9 (95% confidence interval: 2.16-3.91) for Clostridium difficile infection. Other PPH patients had lower odds of acquiring HAI compared to non-PPH patients, and results were frequently significant.ConclusionsClinical implications include increased risk of HAI among diabetic patients admitted for lower extremity amputation. Methodological implications include identification of rare events for inpatient subpopulations and the need for improved codification of HAIs to improve cost and policy analyses regarding allocation of resources toward clinical improvements

Potentially Preventable Hospitalizations and the Burden of Healthcare-Associated Infections.

BackgroundAn estimated 4% of hospital admissions acquired healthcare-associated infections (HAIs) and accounted for $9.8 (USD) billion in direct cost during 2011. In 2010, nearly 140 000 of the 3.5 million potentially preventable hospitalizations (PPHs) may have acquired an HAI. There is a knowledge gap regarding the co-occurrence of these events.AimsTo estimate the period occurrences and likelihood of acquiring an HAI for the PPH population.MethodsRetrospective, cross-sectional study using logistic regression analysis of 2011 Texas Inpatient Discharge Public Use Data File including 2.6 million admissions from 576 acute care hospitals. Agency for Healthcare Research and Quality Prevention Quality Indicator software identified PPH, and existing administrative data identification methodologies were refined for Clostridium difficile infection, central line-associated bloodstream infection, catheter-associated urinary tract infection, and ventilator-associated pneumonia. Odds of acquiring HAIs when admitted with PPH were adjusted for demographic, health status, hospital, and community characteristics.FindingsWe identified 272 923 PPH, 14 219 HAI, and 986 admissions with PPH and HAI. Odds of acquiring an HAI for diabetic patients admitted for lower extremity amputation demonstrated significantly increased odds ratio of 2.9 (95% confidence interval: 2.16-3.91) for Clostridium difficile infection. Other PPH patients had lower odds of acquiring HAI compared to non-PPH patients, and results were frequently significant.ConclusionsClinical implications include increased risk of HAI among diabetic patients admitted for lower extremity amputation. Methodological implications include identification of rare events for inpatient subpopulations and the need for improved codification of HAIs to improve cost and policy analyses regarding allocation of resources toward clinical improvements