Abstract
BackgroundFinancial incentives represent a potential mechanism to encourage infection prevention by hospitals. In order to characterize the place of financial incentives, we investigated resource utilization and cost associated with hospital-acquired infections (HAI) and assessed the relative financial burden for hospital and insurer according to reimbursement policies.MethodsWe conducted a prospective matched case-control study over 18 months in a tertiary university medical center. Patients with central-line associated blood-stream infections (CLABSI), Clostridium difficile infection (CDI) or surgical site infections (SSI) were each matched to three control patients. Resource utilization, costs and reimbursement (per diem for CLABSI and CDI, diagnosis related group (DRG) reimbursement for SSI) were compared between patients and controls, from both the hospital and insurer perspective.ResultsHAIs were associated with increased resource consumption (more blood tests, imaging, antibiotic days, hospital days etc.). Direct costs were higher for cases vs. controls (CLABSI: $6400 vs. $2376 (p < 0.001), CDI: $1357 vs $733 (p = 0.047) and SSI: $6761 vs. $5860 (p < 0.001)). However as admissions were longer following CLABSI and CDI, costs per-day were non-significantly different (USD/day, cases vs. controls: CLABSI, 601 vs. 719, (p = 0.63); CDI, 101 vs. 93 (p = 0.5)). For CLABSI and CDI, reimbursement was per-diem and thus the financial burden ($14,608 and $5430 respectively) rested on the insurer, not the hospital. For SSI, as reimbursement was per procedure, costs rested primarily on the hospital rather than the insurer.ConclusionNosocomial infections are associated with both increased resource utilization and increased length of stay. Reimbursement strategy (per diem vs DRG) is the principal parameter affecting financial incentives to prevent hospital acquired infections and depends on the payer perspective. In the Israeli health care system, financial incentives are unlikely to represent a significant consideration in the prevention of CLABSI and CDI.
Highlights
Introduction to "A Compendium ofStrategies to Prevent HealthcareAssociated Infections in Acute Care Hospitals: 2014 Updates". 2014, Infection Control and Hospital Epidemiology.12
Hospital costs Resource consumption Use of blood tests, cultures, scans, duration of antibiotic treatment, length of stay and overall costs during 1st hospitalization were significantly higher for hospital-acquired infections (HAI) patients than controls (Table 2)
For central-line associated blood-stream infections (CLABSI) and Clostridium difficile infection (CDI) expenses per day were similar for cases and controls, as both costs and overall length of stay were higher
Summary
Introduction to "A Compendium ofStrategies to Prevent HealthcareAssociated Infections in Acute Care Hospitals: 2014 Updates". 2014, Infection Control and Hospital Epidemiology.12. During the course of their hospital stay approximately 5–10% of patients develop a hospital acquired infection (HAI) [1]. Such infections are associated with morbidity, mortality, increased lengths of stay and costs [2,3,4,5,6,7,8,9]. Nosocomial infections usually affect more severely ill patients, who often have long, complex and expensive hospital courses regardless. Estimates of attributable costs of nosocomial infections are often based on cohort or database analyses that do not directly compare the costs of HAI to the costs of admission for complex patients. The origins of costs related to HAIs have not been clearly delineated
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