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Polage CR, Quan KA, Madey KM, Meyers F, Krishna S, Grein J, Gibbs L, Yokoe DS, Mabalot SC, Chinn R, Hallmark A, Rubin ZA, Fontenot M, Cohen S, Wightman D, Birnbaum D, Huang SS, Torriani FJ. 84. Evaluation of the NHSN Standardized Infection Ratio (SIR) Risk Adjustment for HO-CDI in Oncology and ICU Patients in General Acute Care Hospitals. Open Forum Infect Dis 2019. [PMCID: PMC6808989 DOI: 10.1093/ofid/ofz359.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
The NHSN healthcare-facility onset Clostridioides difficile infection (CDI) standardized infection ratio (SIR) is used to compare hospital quality and set hospital reimbursement but inadequate risk adjustment could penalize hospitals unnecessarily. We hypothesized that general hospitals with large oncology and/or ICU populations were not fully adjusted in the 2015 NHSN acute care hospital CDI Laboratory-Identified (LabID) event prediction model and SIRs would be affected.
Methods
We validated a negative binomial regression HO-CDI event prediction model identical to the 2015 published model and used FY2016 data from eight general hospitals in California to test our hypothesis. We compared HO-CDI events and SIR values, with and without oncology/hematopoietic stem cell transplant or ICU unit events, patient-days, admissions, bed counts, and adjustment parameters included.
Results
Seven major teaching and one nonteaching general acute care hospitals were included (see Table). Eight had oncology/hematopoietic stem cell transplant units; seven had ≥43 ICU beds (median: 134; interquartile range [IQR]: 84–161). The median facility unmodified FacWideIn SIR was 1.23 [IQR: 1.15, 1.29]. Removal of oncology unit data resulted in a 15% median facility decrease in HO-CDI events (IQR: 14%, 21%) and −8% median facility decrease in SIR (IQR: −2%, −14%). Removal of ICU unit data resulted in a 22% median facility decrease in HO-CDI events (IQR: 16%, 26%) and 97% median facility increase in SIR at each facility (IQR: 78%, 105%).
Conclusion
The ICU bed adjustment in the 2015 NHSN SIR is a powerful correction that fully adjusted for ICU HO-CDI events at all hospitals in the study. However, the lack of risk adjustment for oncology/hematopoietic stem cell transplant unit HO-CDI events suggests that the current model unfairly penalizes general acute facilities, many of which also provide specialized oncologic care. Thus, the model needs to be re-adjusted to account for this important specialty care population in general acute care facilities.
Disclosures
All Authors: No reported Disclosures.
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Affiliation(s)
| | | | | | | | - Sneha Krishna
- Cedars-Sinai Medical Center, Los Angeles, California
| | | | | | - Deborah S Yokoe
- University of California, San Francisco, San Francisco, California
| | | | - Raymond Chinn
- Sharp Metropolitan Medical Campus, San Diego, California
| | | | | | | | | | | | | | - Susan S Huang
- University of California, Irvine, School of Medicine, Irvine, California
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Williston M, Fontenot M, Pope J, Erickson D. The Effects of a Low-Glycemic Index Diabetes Management Program on Weight, Body Mass Index, Triglycerides, Cholesterol and Hemoglobin A1c Values. J Acad Nutr Diet 2019. [DOI: 10.1016/j.jand.2019.06.078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Robichaux A, Fontenot M, Stedman C, Jaekle R, Newman M, Dotson T, Lewis D. 335 Does delayed delivery with PIH <37 weeks and massive proteinuria increase maternal risks? Am J Obstet Gynecol 2001. [DOI: 10.1016/s0002-9378(01)80366-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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