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Potentially Preventable Hospitalizations and the Burden of Healthcare-Associated Infections
Andrea L Lorden1,2, Luohua Jiang3,4, Tiffany A Radcliff1
1Department of Health Policy and Management, School of Public Health, Texas A&M Health Science Center, College Station, TX, USA.
Insights
Diabetic patients with lower extremity amputations face a higher risk of healthcare-associated infections (HAIs), particularly Clostridium difficile. This study highlights the need for better data to improve patient safety and resource allocation.
Area of Science:
- Healthcare epidemiology
- Infectious disease prevention
- Health services research
Background:
- Healthcare-associated infections (HAIs) represent a significant burden, costing billions annually.
- Potentially preventable hospitalizations (PPHs) are a subset of admissions at risk for HAIs.
- Limited data exists on the co-occurrence of PPH and HAI.
Purpose of the Study:
- To determine the incidence and risk of HAIs among patients with PPH.
- To identify specific patient populations with elevated HAI risk within the PPH group.
Main Methods:
- Retrospective analysis of 2.6 million Texas hospital admissions from 2011.
- Utilized Agency for Healthcare Research and Quality Prevention Quality Indicator software to identify PPH.
- Refined methods for identifying specific HAIs: C. difficile, CLABSI, CAUTI, VAP.
- Logistic regression adjusted for patient, hospital, and community factors.
Main Results:
- Identified 272,923 PPHs, 14,219 HAIs, and 986 with both PPH and HAI.
- Diabetic patients undergoing lower extremity amputation had a 2.9-fold increased odds of C. difficile infection.
- PPH patients generally had lower odds of HAI compared to non-PPH patients, with significant findings.
Conclusions:
- Clinical takeaway: heightened HAI risk for diabetics with lower extremity amputations.
- Methodological insight: importance of identifying rare events in subpopulations.
- Need for improved HAI coding to enhance cost and policy analysis for clinical improvements.
Background:
An 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.
Aims:
To estimate the period occurrences and likelihood of acquiring an HAI for the PPH population.
Methods:
Retrospective, 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.
Findings:
We 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.
Conclusions:
Clinical 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.
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