Hospital readmission with Clostridium difficile infection as a secondary diagnosis is associated with worsened outcomes and greater revenue loss relative to principal diagnosis: A retrospective cohort study.

MedStar author(s):
Citation: Medicine. 97(36):e12212, 2018 Sep.PMID: 30200134Institution: MedStar Washington Hospital CenterDepartment: Medicine/Pulmonary-Critical CareForm of publication: Journal ArticleMedline article type(s): Comparative Study | Journal Article | Multicenter Study | Observational StudySubject headings: *Clostridium Infections/di [Diagnosis] | *Clostridium Infections/th [Therapy] | *Patient Readmission | Adolescent | Adult | Aged | Clostridium Infections/ec [Economics] | Clostridium Infections/mo [Mortality] | Female | Follow-Up Studies | Health Care Costs | Hospital Mortality | Humans | Length of Stay/ec [Economics] | Male | Middle Aged | Patient Readmission/ec [Economics] | Retrospective Studies | United States | Young AdultYear: 2018Local holdings: Available online from MWHC library: 1995 - present, Available in print through MWHC library: 1999 - 2006ISSN:
  • 0025-7974
Name of journal: MedicineAbstract: Recurrent Clostridium difficile infection (rCDI) requiring rehospitalization contributes to poor outcomes, which may differ between patients hospitalized with versus for it.We performed a multicenter retrospective cohort study of rehospitalized adults surviving initial CDI hospitalization. Hospital mortality, length of stay (LOS), 30-day readmission, and mean gap between hospital costs and Diagnosis Related Group (DRG) reimbursement served as outcomes.Among the 25.7% (n = 99,175) survivors requiring rehospitalization, 36,504 (36.8%) had rCDI (14,005 [38.4%] principal diagnosis rCDI [PrCDI]). Compared with non-CDI, PrCDI, and secondary diagnosis rCDI [SrCDI] carried lower risk of death (PrCDI odds ratio [OR] 0.52; 95% confidence interval [CI] 0.46, 0.58; SrCDI OR 0.80; 95% CI 0.75, 0.85) and 30-day readmission (PrCDI OR 0.84; 95% CI 0.80, 0.88; SrCDI OR 0.97; 95% CI 0.94, 1.01), and excess LOS (PrCDI 1.8 days; 95% CI 1.7, 2.0; SrCDI 1.4 days; 95% CI 1.3, 1.5), and costs (PrCDI All authors: Hawkshead JJ 3rd, Marcella S, Nathanson BH, Shorr AF, Zilberberg MDFiscal year: FY2019Digital Object Identifier: Date added to catalog: 2018-09-28
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Item type Current library Collection Call number Status Date due Barcode
Journal Article MedStar Authors Catalog Article 30200134 Available 30200134

Available online from MWHC library: 1995 - present, Available in print through MWHC library: 1999 - 2006

Recurrent Clostridium difficile infection (rCDI) requiring rehospitalization contributes to poor outcomes, which may differ between patients hospitalized with versus for it.We performed a multicenter retrospective cohort study of rehospitalized adults surviving initial CDI hospitalization. Hospital mortality, length of stay (LOS), 30-day readmission, and mean gap between hospital costs and Diagnosis Related Group (DRG) reimbursement served as outcomes.Among the 25.7% (n = 99,175) survivors requiring rehospitalization, 36,504 (36.8%) had rCDI (14,005 [38.4%] principal diagnosis rCDI [PrCDI]). Compared with non-CDI, PrCDI, and secondary diagnosis rCDI [SrCDI] carried lower risk of death (PrCDI odds ratio [OR] 0.52; 95% confidence interval [CI] 0.46, 0.58; SrCDI OR 0.80; 95% CI 0.75, 0.85) and 30-day readmission (PrCDI OR 0.84; 95% CI 0.80, 0.88; SrCDI OR 0.97; 95% CI 0.94, 1.01), and excess LOS (PrCDI 1.8 days; 95% CI 1.7, 2.0; SrCDI 1.4 days; 95% CI 1.3, 1.5), and costs (PrCDI 399; 95% CI 58, 939; SrCDI 809; 95% CI 307, 311). Mean gap between hospital costs and DRG reimbursements was highest in SrCDI ( 3,803).A rehospitalization within 60-days of an initial CDI hospitalization occurs in approximately 25% of all survivors, 1/3 with rCDI. SrCDI carries worse outcomes than PrCDI. The potential loss of revenue incurred by the hospital is nearly 3-fold higher for SrCDI than PrCDI.

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