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The Impact of Healthcare-Associated Methicillin-Resistant Staphylococcus Aureus Infections on Post-Discharge Healthcare Costs and Utilization

Published online by Cambridge University Press:  26 February 2015

Richard E. Nelson ,
Makoto Jones ,
Chuan-Fen Liu ,
Matthew H. Samore ,
Martin E. Evans ,
Nicholas Graves ,
Bruce Lee  and
Michael A. Rubin
Richard E. Nelson*
Affiliation:
Veterans Affairs Salt Lake City Health Care System, Salt Lake City, Utah Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, Utah
Makoto Jones
Affiliation:
Veterans Affairs Salt Lake City Health Care System, Salt Lake City, Utah Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, Utah
Chuan-Fen Liu
Affiliation:
Veterans Affairs Puget Sound Health Care System, Seattle, Washington Department of Health Services, University of Washington, Seattle, Washington
Matthew H. Samore
Affiliation:
Veterans Affairs Salt Lake City Health Care System, Salt Lake City, Utah Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, Utah
Martin E. Evans
Affiliation:
Lexington Veterans Affairs Medical Center, Lexington, Kentucky MRSA/MDRO Program, National Infectious Diseases Service, Veterans Health Administration, Lexington, Kentucky Department of Internal Medicine, University of Kentucky, Lexington, Kentucky
Nicholas Graves
Affiliation:
School of Public Health and Institute for Health & Biomedical Innovation, Queensland University of Technology, Brisbane, Australia
Bruce Lee
Affiliation:
Department of International Health, Johns Hopkins University, Baltimore, Maryland
Michael A. Rubin
Affiliation:
Veterans Affairs Salt Lake City Health Care System, Salt Lake City, Utah Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, Utah
*
Address all correspondence to Richard E. Nelson, PhD, 500 Foothill Blvd, Salt Lake City, UT 84148 (richard.nelson@utah.edu).
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Abstract

OBJECTIVE

Healthcare-associated methicillin-resistant Staphylococcus aureus (MRSA) infections are a major cause of morbidity, mortality, and cost among hospitalized patients. Little is known about their impact on post-discharge resource utilization. The purpose of this study was to estimate post-discharge healthcare costs and utilization attributable to positive MRSA cultures during a hospitalization.

METHODS

Our study cohort consisted of patients with an inpatient admission lasting longer than 48 hours within the US Department of Veterans Affairs (VA) system between October 1, 2007, and November 30, 2010. Of these patients, we identified those with a positive MRSA culture from microbiology reports in the VA electronic medical record. We used propensity score matching and multivariable regression models to assess the impact of positive culture on post-discharge outpatient, inpatient, and pharmacy costs and utilization in the 365 days following discharge.

RESULTS

Our full cohort included 369,743 inpatients, of whom, 3,599 (1.0%) had positive MRSA cultures. Our final analysis sample included 3,592 matched patients with and without positive cultures. We found that, in the 12 months following hospital discharge, having a positive culture resulted in increases in post-discharge pharmacy costs ($776, P<.0001) and inpatient costs ($12,167, P<.0001). Likewise, having a positive culture increased the risk of a readmission (odds ratio [OR]=1.396, P<.0001), the number of prescriptions (incidence rate ratio [IRR], 1.138; P<.0001) and the number of inpatient days (IRR, 1.204; P<.0001,) but decreased the number of subsequent outpatient encounters (IRR, 0.941; P<.008).

CONCLUSIONS

The results of this study indicate that MRSA infections are associated with higher levels of post-discharge healthcare cost and utilization. These findings indicate that financial benefits resulting from infection prevention efforts may extend beyond the initial hospital stay.

Infect Control Hosp Epidemiol 2015;00(0): 1–9

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 36 , Issue 5 , May 2015 , pp. 534 - 542
Copyright
© 2015 by The Society for Healthcare Epidemiology of America. All rights reserved 

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