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Assessing the burden of Clostridium difficile infections for hospitals.
J Hosp Infect. 2017 Sep 07;:
Authors: Hebbinckuys E, Marissal JP, Preda C, Leclercq V
Abstract
BACKGROUND: Nosocomial infections place a heavy burden on the healthcare system. However, quantifying the burden raises many questions, ranging from the way to accurately estimate the extra length of stay at hospital to defining and costing the preventative methods among the different care providers.
METHOD: We used multi state modeling based on Markov processes and bootstraping to derive individual estimates of the prolongation of stay at hospital associated with Clostridium difficile infection (CDI). We then computed indicators of cost for hospitals, including an estimation of the productivity losses derived from DRG-based payment systems.
POPULATION: Patients aged 55 and over, admitted in two hospital facilities in Lille, Saint Philibert, Lomme and Saint Vincent de Paul, Lille, North of France, with and without an episode of CDI from January 1(st) 2013 to September 15(th) 2014.
RESULTS: A total of 52 episodes were screened during the study period. The estimated mean cost of CDI was approximately €23,909 (SD = 17,458) for an extended length of hospital stay (N = 27). In the case of a reduced length of the hospital stay (N = 25), the mean cost was approximately € -14,697 (SD = 16,936), which represents net savings for the hospitals. The main cost/savings driver was the productivity losses/gains resulting from the nosocomial infection. A sensitivity analysis showed that the main factor explaining the amount of costs or savings due to nosocomial infections was the length of the hospital stay.
CONCLUSION: We discuss the notion of productivity gains in the case of deaths as a factor revealing the incompleteness of the payment systems. We then discuss the methodological issues associated with the statistical method used to control for temporality bias.
PMID: 28890287 [PubMed - as supplied by publisher]