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Recurrent Clostridium difficile infection among Medicare patients in nursing homes: A population-based cohort study
Marya D Zilberberg1, Andrew F Shorr, William M Jesdale
1EviMed Research Group, LLC, Goshen School of Public Health and Health Sciences, University of Massachusetts, Amherst, MA Washington Hospital Center, Washington, DC University of Massachusetts Medical School, Worcester, MA, USA.
Abstract:
We explored the epidemiology and outcomes of Clostridium difficile infection (CDI) recurrence among Medicare patients in a nursing home (NH) whose CDI originated in acute care hospitals.We conducted a retrospective, population-based matched cohort combining Medicare claims with Minimum Data Set 3.0, including all hospitalized patients age ≥65 years transferred to an NH after hospitalization with CDI 1/2011-11/2012. Incident CDI was defined as ICD-9-CM code 008.45 with no others in prior 60 days. CDI recurrence was defined as (within 60 days of last day of CDI treatment): oral metronidazole, oral vancomycin, or fidaxomicin for ≥3 days in part D file; or an ICD-9-CM code for CDI (008.45) during a rehospitalization. Cox proportional hazards and linear models, adjusted for age, gender, race, and comorbidities, examined mortality within 60 days and excess hospital days and costs, in patients with recurrent CDI compared to those without.Among 14,472 survivors of index CDI hospitalization discharged to an NH, 4775 suffered a recurrence. Demographics and clinical characteristics at baseline were similar, as was the risk of death (24.2% with vs 24.4% without). Median number of hospitalizations was 2 (IQR 1-3) among those with and 0 (IQR 0-1) among those without recurrence. Adjusted excess hospital days per patient were 20.3 (95% CI 19.1-21.4) and Medicare reimbursements $12,043 (95% CI $11,469-$12,617) in the group with a recurrence.Although recurrent CDI did not increase the risk of death, it was associated with a far higher risk of rehospitalization, excess hospital days, and costs to Medicare.
Insights
Recurrent Clostridium difficile infection (CDI) in nursing home patients did not increase mortality but significantly raised rehospitalization rates, hospital days, and Medicare costs. This highlights the economic and healthcare burden of recurrent CDI.
Area of Science:
- Epidemiology
- Healthcare Management
- Infectious Diseases
Background:
- Clostridium difficile infection (CDI) is a significant healthcare-associated infection.
- Recurrence of CDI poses a substantial burden on patients and healthcare systems.
- Understanding outcomes of recurrent CDI in nursing home populations is crucial for effective management.
Purpose of the Study:
- To investigate the epidemiology and outcomes of recurrent CDI in Medicare patients residing in nursing homes.
- To compare mortality, rehospitalization, hospital days, and costs between patients with and without recurrent CDI.
- To identify the impact of recurrent CDI on healthcare resource utilization.
Main Methods:
- Retrospective, population-based matched cohort study using Medicare claims and Minimum Data Set 3.0.
- Included patients aged ≥65 years transferred to a nursing home after hospitalization with CDI.
- Defined incident and recurrent CDI using ICD-9-CM codes and medication data; analyzed outcomes using Cox proportional hazards and linear models.
Main Results:
- Among 14,472 patients, 4775 experienced recurrent CDI.
- Recurrent CDI was not associated with increased 60-day mortality (24.2% vs 24.4%).
- Recurrent CDI patients had significantly more hospitalizations (median 2 vs 0), excess hospital days (20.3), and higher Medicare costs ($12,043).
Conclusions:
- Recurrent CDI in nursing home patients does not elevate mortality risk.
- Recurrent CDI is strongly linked to increased rehospitalizations, prolonged hospital stays, and substantial financial costs for Medicare.
- Strategies to prevent CDI recurrence are essential to mitigate healthcare resource utilization and costs.
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