Lorden, Andrea L (2014-07). The Prevalence and Incremental Costs of Healthcare Associated Infections for Individuals Admitted for Potentially Preventable Hospitalization. Doctoral Dissertation.
Thesis
Since there is a limited literature base concerning individuals admitted with a potentially preventable hospitalization (PPH) who acquired a healthcare associated infection (HAI), this research identified the prevalence and costs of individuals admitted to Texas hospitals in 2011 for a PPH and acquired an HAI. Based on IOM identified associations between PPH and uninsurance, the analytic evaluation draws from theoretical models that link insurance status to outcomes such as PPH. Using the hypothesis that the cost of preventive care for the uninsured with ambulatory care sensitive conditions (ACSC) that lead to PPH would be less than the incremental cost of healthcare for HAI in individuals admitted with a PPH and acquired an HAI, I estimated costs for ACSC related preventive care, PPH, and the incremental cost of HAI. The Agency for Healthcare Research and Quality (AHRQ) Quality Indicator modules identified PPH using administrative inpatient discharge data and private insurer claims data. Adjusting for demographic, community and hospital characteristics, logistic regression analysis estimated odds ratios of PPH individuals acquiring an HAI, and generalized least squared regression estimated costs needed to address the hypothesis. I identified 1,031 individuals in the 2011 Texas inpatient discharge data with both a PPH and an HAI. 66% of the PPH with HAI population identified Medicare as their primary payer, and 7% identified Self-pay or Charity as primary payer. Most PPH individuals had lower odds of acquiring an HAI. However, individuals admitted with diabetes related lower extremity amputation demonstrated a significantly higher odds of acquiring either Clostridium difficile infection (OR: 2.9, CI_(95%) 2.16, 3.91) or ventilator associated pneumonia (OR: 1.4, CI_(95%) 0.95, 2.18). The adjusted mean cost per hospitalization for PPH was approximately $2,000 less than the general inpatient population. The estimated incremental cost of HAI for the 97 uninsured individuals in the PPH and HAI population was $2.1 million. The cost of preventive healthcare for uninsured individuals in Texas with an ACSC was estimated at $66.8 billion. Given the large proportion of insured within the PPH with HAI population, and the incremental cost of HAI quantified, I recommend additional research focusing on the Medicare population affected.
