The impact of healthcare-associated methicillin-resistant Staphylococccus aureus infections among US veterans on post-discharge healthcare cost and utilization outside the Department of Veterans Affairs healthcare system

Background:

Healthcare-associated infections (HAIs) can result in mortality and are a major financial burden for hospitalized patients. Methicillin-resistant Staphylococcus aureus (MRSA) is a primary pathogen causing these infections. Following hospital discharge, healthcare utilization attributable to MRSA HAIs is not entirely known, especially outside the health system boundaries of the initial admission. The purpose of this study was to estimate VeteransÕ post-discharge healthcare utilization in non-Veterans Affairs (VA) healthcare system settings attributable to MRSA HAIs.

Methods:

Our analysis included healthcare reimbursement payments made by Medicare and the VA (through Fee Basis care) for healthcare encounters that occurred outside the VA healthcare system following an inpatient admission in a VA hospital between October 1, 2007 through September 30, 2010. We compared the utilization and cost of care between Veterans with a positive MRSA culture during the initial hospitalization with those who did not. We used propensity score matching and regression analyses to assess the impact of MRSA-positive cultures on outpatient, inpatient, and emergency department (ED) costs and utilization for 12 months following hospital discharge. Regression models included generalized linear models for cost outcomes, logistic models for binary outcomes (inpatient admissions), and zero-inflated negative binomial models for count outcomes (outpatient and emergency department encounters).

Results:

Our propensity score-matched cohorts consisted of 7184 patients who were included in the Fee Basis analyses and 3900 patients who were enrolled in Medicare and were therefore included in our CMS cohort. The average age was 71 and 65 for those in the Fee Basis and Medicare analysis cohorts, respectively. The results from our analyses can be found in Figure 1.

Conclusion:

These results indicate that MRSA infections may be associated with increased post-discharge healthcare cost and utilization from non-VA providers. With the anticipated rise in VA-subsidized care from non-VA providers due to the Veterans Access, Choice, and Accountability Act of 2014, these findings help policy makers understand the potential post-discharge burden of MRSA HAIs.