000			03524nam a22006017a 4500
008			180928s20182018 xxu||||| |||| 00| 0 eng d
022			_a0025-7974
024			_a00005792-201809070-00076 [pii]
024			_a10.1097/MD.0000000000012212 [doi]
040			_aOvid MEDLINE(R)
099			_a30200134
245			_aHospital 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.
251			_aMedicine. 97(36):e12212, 2018 Sep.
252			_aMedicine (Baltimore). 97(36):e12212, 2018 Sep.
253			_aMedicine
260			_c2018
260			_fFY2019
265			_sppublish
266			_d2018-09-28
501			_aAvailable online from MWHC library: 1995 - present, Available in print through MWHC library: 1999 - 2006
520			_aRecurrent 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 _1399; 95% CI _858, _1939; SrCDI _2809; 95% CI _2307, _3311). Mean gap between hospital costs and DRG reimbursements was highest in SrCDI ( _13,803).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.
546			_aEnglish
650			_a*Clostridium Infections/di [Diagnosis]
650			_a*Clostridium Infections/th [Therapy]
650			_a*Patient Readmission
650			_aAdolescent
650			_aAdult
650			_aAged
650			_aClostridium Infections/ec [Economics]
650			_aClostridium Infections/mo [Mortality]
650			_aFemale
650			_aFollow-Up Studies
650			_aHealth Care Costs
650			_aHospital Mortality
650			_aHumans
650			_aLength of Stay/ec [Economics]
650			_aMale
650			_aMiddle Aged
650			_aPatient Readmission/ec [Economics]
650			_aRetrospective Studies
650			_aUnited States
650			_aYoung Adult
651			_aMedStar Washington Hospital Center
656			_aMedicine/Pulmonary-Critical Care
657			_aComparative Study
657			_aJournal Article
657			_aMulticenter Study
657			_aObservational Study
700			_aShorr, Andrew F
790			_aHawkshead JJ 3rd, Marcella S, Nathanson BH, Shorr AF, Zilberberg MD
856			_uhttps://dx.doi.org/10.1097/MD.0000000000012212 _zhttps://dx.doi.org/10.1097/MD.0000000000012212
942			_cART _dArticle
999			_c3774 _d3774