PS1-39 ECONOMIC TRENDS FROM 2004 – 2011 FOR CLOSTRIDIUM DIFFICILE INFECTION FOR INTENSIVE CARE AND OTHER INPATIENTS: A RETROSPECTIVE, COHORT STUDY

Sunday, October 18, 2015
Grand Ballroom EH (Hyatt Regency St. Louis at the Arch)
Poster Board # PS1-39

Matthew Hutcherson, BS1, Nicole Zimmerman, MS2, Chiedozie Udeh, MD3, J. Steven Hata, MD4, Joe Zein, MD5, Abhishek Deshpande, MD6, Simon Lam, PharmD, RPh7, Jarrod E. Dalton, PhD8 and Belinda Udeh, PhD, MPH1, (1)Department of Outcomes Research, Anesthesiology Institute, Cleveland Clinic, Cleveland, OH, (2)Departments of Outcomes Research and Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH, (3)Critical Care Center and Department of Cardiothoracic Anesthesiology, Cleveland Clinic, Cleveland, OH, (4)Critical Care Center and Departments of General Anesthesiology and Cardiothoracic Anesthesiology, Cleveland Clinic, Cleveland, OH, (5)Departments of Pulmonary Medicine and Critical Care Medicine, Cleveland Clinic, Cleveland, OH, (6)Center for Value Based Care Research, Medicine Institute, Cleveland Clinic, Cleveland, OH, (7)Department of Pharmacy, Cleveland Clinic, Cleveland, OH, (8)Cleveland Clinic, Cleveland, OH
Purpose:   Clostridium difficileinfection (CDI) is a common nosocomial infection responsible for prolonged hospitalization, increased mortality, and increased cost. This study aimed to determine the time trends in incidence, mortality, and costs for CDI from 2004–2011 for all inpatients, and patients admitted to the intensive care unit (ICU).

Method:   Nearly 32 million inpatient discharges were analyzed between 2004 and 2011 from the California State Inpatient Database. CDI was defined by the ICD-9-CM code (008.45). Propensity matching was used, adjusting for potential confounding in 24,806 matched pairs. Quantile regression modeled incremental charges as the response variable and the year of discharge as the predictor to evaluate trends in incremental charges over time, adjusted to 2012 U.S. dollars. The model included an interaction between year of discharge and ICU status to assess whether trends differed by ICU status. Trends in incidence, mortality, incremental length of stay (LOS), and discharge destination were also evaluated.

Result:   Median incremental charges were $115,000 [$17,000, $289,000] for all CDI inpatients and $193,000 [$6,000, $442,000] for CDI patients in ICU. The Wald test revealed a significant linear trend over time (P<0.001) for inpatients, with the median and 90th percentile annual decrease in incremental charges $5,170 [$2,760, $7,580] and $11,290 [$2,320, $20,250] respectively. Among ICU patients, there was a significant annual increase (P<0.001) of 90thpercentile incremental charges of $18,660 [$910, $36,400]. Median incremental LOS decreased annually by 0.46 [0.30, 0.61; P<0.001] days for inpatients and 0.39 [0.06,0.73; P<0.001] for ICU patients; the 90th percentile incremental LOS decreased annually by 1.19 [0.64,1.73; P<0.001] days among non-ICU patients but showed no linear trend among ICU patients. CDI patients were more likely to be transferred to a skilled-nursing facility, regardless of ICU status. The incidence of CDI was 3.90 cases per 1000 patients [95% CI: 3.86-3.95] with an in-hospital mortality of 17.5% [95% CI: 17.0%, 17.9%], with no significant time trends noted. 

Conclusion:   From 2004 – 2011, small decreases were seen in median charges and LOS for the inpatient and ICU population. With no changes in mortality, these decreases may be attributable to overall improvements in hospital efficiency rather than CDI care. The higher proportion of patients transferred to skilled-nursing may also contribute to these charge and LOS decreases.

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