Methods: As a means to adjust for increasing molecular diagnostics, a SIR model of analysis for initiative outcomes was chosen. The SIR model used by CDC’s National Healthcare Safety Network (NHSN) was initially evaluated, but as the VA healthcare-system is not representative of the CDC facilities participating in NHSN, adaption was needed to account for VA-specific characteristics. The adapted model included NHSN variables of hospital size, C diff prevalence, diagnostic testing modality and affiliation with medical training customized to the VA system. Analysis of quarterly increments of data was undertaken from July 2012 through June 2014.
Results: Using data from Oct 2010 through June 2012 as a baseline for comparison, during the two-year goal period, the raw rates of HO-HCFA declined from 9.40/10,000 Bed Days of Care in the baseline period to 8.62 in the final quarter (8.3% decrease). Using the SIR to account for use of molecular testing and other variables, the rates using a SIR model decreased by 7% (SIR =0.93) in the first quarter and continued to decrease to 16% (SIR=0.84) by the final quarter period (p=0.02, for quarterly decline by linear regression).
Conclusion: A SIR Model can be customized to the VA healthcare system to track infections such as C diff, while accounting for some of the unique characteristics of the healthcare system. While VA did not achieve its goal of 30% reduction, the use of a SIR model demonstrates the importance of accounting for variables which can influence rates and can help to determine additional strategies to achieve C diff prevention initiative goals.
L. Simbartl, None
G. Roselle, None
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