569. Economic Burden of Nosocomial Infection on Payers and Providers: Analysis of 272,143 Admissions in 2007
Session: Poster Session: Hospital-acquired and Transplant Infections
Friday, October 30, 2009: 12:00 AM
Room: Poster Hall A
Background: Large scale research on economic burden of nosocomial infection tends to be limited on hospital charge data for cost estimate and coded diagnosis data for infection case identification, which may suffer from imprecision and coding practice variations.
Methods: We selected 129 hospitals with complete cost, reimbursement, and net income data for Medicare patients discharged in 2007 in the MedMinedTM Research Data Base. This database contains a nosocomial infection marker (NIM™) electronically generated from real time microbiology and census data. We fit multivariable mixed models to estimate attributable cost, CMS payment, and net income of NIM by the infection source, controlling for age, disease related groups (DRGs), and the geographic region.
Results: Out of 272,143 admissions in the study cohort, 28,694 NIM episodes were identified among 19,563 (7.2%) patients. The relative distribution of NIM episodes by source of infection in descending order was 41.3% (urinary tract), 19.7% (respiratory), 14.5% (blood), 10.7% (surgical site), 7.6% (Clostridium difficile), and 6.2% (other sources). The adjusted attributable cost per NIM was $14,972, $12,763, $9,723, $8,117, $7,210, and $8,985, for respiratory, blood, surgical site, Clostridium difficile, urinary tract, and other sources, respectively. The adjusted additional reimbursement per NIM from the CMS was $8,310, $5,702, $3,945, $2,729, $2,439, and $4,098, respectively. The adjusted attributable net loss per NIM for hospitals after CMS reimbursement was $6,663, $7,061, $5,778, $5,388, $4,772, and $4,887, respectively. All p-values were <.0001.
Conclusion: Nosocomial infections constitute a great burden to both payers and providers. The adjusted attributable CMS payment per NIM ranged from $2,439 (urinary tract infection) to $8,310 (blood stream infection). The respective attributable net loss per NIM for hospitals ranged from $4,772 to $7,061.
Stephen Brossette, MD, PhD1, Patrick Hymel, MD2, R Johannes, MD, MS3, Xiaowu Sun, PhD4, Ying Tabak, PhD4 and  S. E. Brossette,
Cardinal Health Role(s): Employee, Received: Salary.
X. Sun,
Cardinal Health Role(s): Employee, Received: Salary.
R. S. Johannes,
Cardinal Health Role(s): Employee, Received: Salary.
P. A. Hymel,
Cardinal Health Role(s): Employee, Received: Salary.
Y. P. Tabak,
Cardinal Health Role(s): Employee, Received: Salary., (1)Cardinal Health, Birmingham, AL, (2)MedMined, Birmingham, AL, (3)Cardinal Health, Marborough, MA, (4)Cardinal Health, Marlborough, MA