1383. The Impact of Clostridium difficile-associated Diarrhea on the Healthcare Utilization of Older and Chronically Ill Patients
Session: Poster Abstract Session: Clostridium difficile
Saturday, October 5, 2013
Room: The Moscone Center: Poster Hall C

Background:

Clostridium difficile-associated diarrhea (CDAD) is associated with excess hospitalizations, readmissions, and post-acute care. This study assesses the impact of CDAD as a secondary diagnosis on the healthcare utilization for Medicare beneficiaries, including older and chronically ill patients.

Methods:

A 5% random sample of Medicare inpatient hospital claims from 2009-2010 was used to identify hospitalizations for patients with secondary CDAD and no hospitalization 30 days prior to the index stay (n=3,262). Propensity score matching was used to identify a cohort of comparator non-CDAD cases (n=3,262). Patient subgroups studied included age ≥65 (n=2,708), renal insufficiency (n=1,357), immunocompromised status (n=1,785), and Medicare Hospital Readmissions Reduction Program (HRRP) conditions (i.e., acute myocardial infarction, heart failure or pneumonia) (n=365) (n for CDAD groups shown). Risk-adjusted length of stay (LOS), intensive care unit (ICU) LOS, 30-day and 60-day readmissions, and skilled nursing facility (SNF) use were evaluated.

Results:

·         Hospital LOS: CDAD patients had longer LOS compared to non-CDAD patients (7.0 versus 3.8 days). In all four subgroups, CDAD was also associated with longer LOS (p<0.001).

·         ICU LOS:  CDAD patients aged 65+ years, with immunocompromised status, and with renal insufficiency had 171%, 198% and 161% more ICU days than non-CDAD patients, respectively (p<0.001 for the odds ratios [OR]). 

·         Readmissions:  CDAD patients aged 65+, with renal insufficiency, or a HRRP condition had statistically significantly higher 30- and 60-day readmission rates than non-CDAD patients (see Figure 1), with the 30-day readmission rate almost doubled in the HRRP group (p=0.017 for the OR).   

·         SNF utilization: The odds of CDAD patients using a SNF were twice as high as non-CDAD patients in the immunocompromised (p=0.011) and renal insufficiency (p<0.001) subgroups.

 

Conclusion:

CDAD as a secondary condition considerably increases LOS, readmissions, and SNF utilization among the elderly and chronically ill, including those with conditions in the HRRP. Implementing more effective prevention and treatment strategies for these patients could improve CDAD outcomes and reduce healthcare utilization.

 

Edward Drozd, PhD1, Shamonda Braithwaite, MBA1, Hemal Shah, PharmD2 and Sheila Thomas, PharmD2, (1)Data Analytics, Avalere Health, LLC, Washington, DC, (2)Optimer Pharmaceuticals, Inc, Jersey City, NJ

Disclosures:

E. Drozd, Optimer Pharmaceuticals, Inc.: Research Contractor, Consulting fee

S. Braithwaite, Optimer Pharmaceuticals: Research Contractor, Consulting fee

H. Shah, Optimer Pharmaceuticals: Employee, Salary

S. Thomas, Optimer Pharmaceuticals, Inc.: Employee, Salary

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