The Impact of Antibiotic Resistant Infection Levels, Outbreaks, & Control Measures on Hospital Expenses-per-Admission
- Presenter:
Chair: Michael Hagan; Discussant: Ed Miller Tue June 6, 2006 13:45-15:15 Room 213
Background: Antibiotic resistant infections are an increasing problem in hospitals in terms of the number of resistant organisms and their prevalence. Consequently, the costs of these infections, in terms of mortality, disability, and money, are also increasing. Antibiotic resistance (AR) increases the costs of care in various ways including increased length of stay, more admissions to ICU, and more intensive resource use by inpatients. Furthermore, these additional costs of care often go unreimbursed. Despite the implied incentive to adopt infection prevention guidelines to reduce these AR related costs, hospitals have implemented these guidelines to varying degrees.
Implementing clinical practice guidelines improves health care quality but, because providers incur the implementation costs while resulting savings accrue to payors, the third party payment system typically poses a barrier to guideline implementation. However, implementing infection prevention guidelines may generate provider savings by reducing hospital acquired, including AR, infections. If AR infection levels are to be contained or reduced, economic research must first focus on potential cost savings to the entity with the greatest influence over the adoption and implementation of preventive interventions-the hospital. In this study, we sought to assess the impact of AR levels, outbreaks, and control measures on hospital level expenses-per-admission.
Methods: We surveyed a nationally representative sample of 670 hospitals (stratified by bed size, teaching status, geographic region, and VA versus non-VA status) regarding levels and outbreaks of AR, their adherence to recommended AR prevention and control guidelines, and availability of information technology. Survey data were linked to the American Hospital Association Annual Survey to incorporate other hospital level financial and operational capacity characteristics. We use regression analysis to assess the impact of AR levels, outbreaks, and control measures on hospital expenses-per-admission.
Results: We estimate two cost models with expenses-per-admission as the dependent variable: one assesses the impact of AR levels and outbreaks; the other the impact of specific infection prevention measures. We find that hospital expenses-per-admission increase with levels of MRSA (the most common AR organism). This result was consistent both when pooling VA and non-VA hospitals, and analyzing non-VA hospitals separately. For non-VA hospitals, higher expenses-per-admission are also related to more recent outbreaks of another AR organism, K-ESBL. Cost models incorporating infection prevention measures found that, for non-VA hospitals, (1) using information technology to automate decisions to reduce errors (including, but not limited to, antibiotic prescribing) have lower expenses-per-admission, and (2) hospitals reporting active involvement of their infection control committee in AR prevention and control have higher expenses-per-admission. The former suggests a cost-saving means for hospitals equipped with the necessary IT, while the latter may just reflect the cost of improving quality.
Discussion: The successful implementation of infection prevention and control measures cannot occur without hospital administration support, and administrators will not support such measures until there is evidence that they are associated with cost savings. In presenting evidence that AR increases costs at the hospital level, the results of this study are a first step in providing the business case for improving infection prevention and control.
