TY - JOUR
T1 - Effect of Clostridium difficile Prevalence in Hospitals and Nursing Homes on Risk of Infection
AU - Joyce, Nina R.
AU - Mylonakis, Eleftherios
AU - Mor, Vincent
N1 - Funding Information:
Conflict of Interest: Professor Mor's Brown research is in an area related to that of several different paid activities. Dr. Mor also periodically serves as a paid speaker at national conferences where he discusses trends and research findings in long term and post acute care. Dr. Mor holds stock of unknown value in PointRight, Inc., an information services company providing advice and consultation to various components of the long-term care and post-acute care industry, including suppliers and insurers. PointRight sells information on the measurement of nursing home quality to nursing homes and liability insurers. Dr. Mor was a founder of the company but has subsequently divested much of his equity in the company and relinquished his seat on the board. Professor Mor chairs the Independent Quality Committee for HRC Manor Care, Inc., a nursing home chain, for which he receives compensation in the range of $20,000 to $40,000. Dr. Mor also serves as chair of a scientific advisory committee for NaviHealth, a post-acute care service organization, for which he also receives compensation in the range of $20,000 to $40,000 per year. Dr. Mor serves as a technical expert panel member on several Center for Medicare and Medicaid Services quality measurement panels. Dr. Mor is a member of the board of directors of Tufts Health Plan Foundation, Hospice Care of Rhode Island, and The Jewish Alliance of Rhode Island. Financial Disclosure: Nina Joyce's time was supported the National Institute of Mental Health, National Institutes of Health under Award T32MH019733. Dr. Mor was supported by National Institute on Aging Program Project P01AG027296. Author Contributions: VM, NJ: study concept and design. NJ: cleaning and analysis of data, writing first draft of manuscript. NJ, VM, EM: editing and revision of manuscript. Sponsor's Role: The funding had no role in the study.
Publisher Copyright:
© 2017, The American Geriatrics Society
PY - 2017/7
Y1 - 2017/7
N2 - Objectives: To assess the effect of facility Clostridium difficile infection (CDI) prevalence on risk of healthcare facility (HFC) acquired CDI. Design: Retrospective cohort study. Setting: Medicare fee-for-service (FFS) claims and skilled nursing facility (SNF) Minimum Data Set 3.0 assessments. Participants: Medicare beneficiaries with 90 days or more of no contact with a HCF before a hospital admission without a CDI diagnosis. Participants were separated into two cohorts: discharged to the community and discharged to a SNF. Measurements: Risk of HCF-acquired CDI associated with CDI prevalence at the index facility measured according to 30-day rehospitalization with a discharge diagnosis of CDI or diagnosis in the SNF after admission. Hospital and SNF CDI prevalence were categorized into three groups: 0% and above and below the median value for facilities with greater than 0% prevalence. Results: Of 817,900 eligible individuals, there were 553,423 admissions in the first cohort (discharged to the community) and 315,109 in the second (discharged to a SNF). In the first cohort, the risk of HCF-acquired CDI was higher for individuals admitted to hospitals with CDI prevalence less than the median (relative risk (RR) = 1.58, 95% confidence interval (CI) = 1.18–2.12) and greater than the median (RR = 2.56, 95% CI = 1.91–3.45) than for those with no CDI. In the second cohort, the risk of HCF-acquired CDI was greater for individuals admitted to a hospital (RR = 1.89, 95% CI = 1.49–2.39) and a SNF (RR = 1.48, 95% CI = 1.31–1.67) with CDI prevalence greater than the median. Conclusion: The risk of HCF-acquired CDI is greater for noninfected individuals admitted to hospitals and SNFs with a high prevalence of CDI.
AB - Objectives: To assess the effect of facility Clostridium difficile infection (CDI) prevalence on risk of healthcare facility (HFC) acquired CDI. Design: Retrospective cohort study. Setting: Medicare fee-for-service (FFS) claims and skilled nursing facility (SNF) Minimum Data Set 3.0 assessments. Participants: Medicare beneficiaries with 90 days or more of no contact with a HCF before a hospital admission without a CDI diagnosis. Participants were separated into two cohorts: discharged to the community and discharged to a SNF. Measurements: Risk of HCF-acquired CDI associated with CDI prevalence at the index facility measured according to 30-day rehospitalization with a discharge diagnosis of CDI or diagnosis in the SNF after admission. Hospital and SNF CDI prevalence were categorized into three groups: 0% and above and below the median value for facilities with greater than 0% prevalence. Results: Of 817,900 eligible individuals, there were 553,423 admissions in the first cohort (discharged to the community) and 315,109 in the second (discharged to a SNF). In the first cohort, the risk of HCF-acquired CDI was higher for individuals admitted to hospitals with CDI prevalence less than the median (relative risk (RR) = 1.58, 95% confidence interval (CI) = 1.18–2.12) and greater than the median (RR = 2.56, 95% CI = 1.91–3.45) than for those with no CDI. In the second cohort, the risk of HCF-acquired CDI was greater for individuals admitted to a hospital (RR = 1.89, 95% CI = 1.49–2.39) and a SNF (RR = 1.48, 95% CI = 1.31–1.67) with CDI prevalence greater than the median. Conclusion: The risk of HCF-acquired CDI is greater for noninfected individuals admitted to hospitals and SNFs with a high prevalence of CDI.
KW - Clostridium Difficile
KW - hospital-acquired infection
KW - Infectious disease
KW - nursing home
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U2 - 10.1111/jgs.14838
DO - 10.1111/jgs.14838
M3 - Article
C2 - 28394408
AN - SCOPUS:85018518021
VL - 65
SP - 1527
EP - 1534
JO - Journal of the American Geriatrics Society
JF - Journal of the American Geriatrics Society
SN - 0002-8614
IS - 7
ER -