Hospital readmission with Clostridium difficile infection as a secondary diagnosis is associated with worsened outcomes and greater revenue loss relative to principal diagnosis

Zilberberg, Marya D.; Nathanson, Brian H.; Marcella, Stephen; Hawkshead, John Jay; Shorr, Andrew F.

doi:10.1097/md.0000000000012212

Cited by 17 publications

(26 citation statements)

References 18 publications

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“… 17 Among patients readmitted with rCDI in the State Inpatient Databases, there is a significant gap in reimbursement of almost US $8000 to US $18,000 for patients who present with rCDI and septicemia on admission. 18 There are several theories regarding the pathophysiological basis for BSI in patients with CDI and rCDI. Most focus on disruption of the gut microbiota and/or a cellular inflammatory response, resulting from an impaired gut barrier function and immune response to CDI toxins.…”

Section: Discussionmentioning

confidence: 99%

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Clinical complications in patients with primary and recurrent Clostridioides difficile infection: A real-world data analysis

et al. 2021

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Objective: Clostridioides difficile infection and recurrent C. difficile infection result in substantial economic burden and healthcare resource use. Sepsis and bowel surgery are known to be serious complications of C. difficile infection. This study evaluated clinical complications in patients with C. difficile infection and recurrent C. difficile infection during a 12-month period following the primary C. difficile infection. Methods: A retrospective analysis of commercial claims data from the IQVIA PharMetrics Plus™ database was conducted for patients aged 18–64 years with an index C. difficile infection episode requiring inpatient stay or an outpatient visit for C. difficile infection followed by a C. difficile infection treatment. Each C. difficile infection episode ended after a 14-day C. difficile infection-claim-free period was observed. Recurrent C. difficile infection was defined as a further C. difficile infection episode within an 8-week window following the claim-free period. Clinical complications were documented over 12 months of follow-up and stratified by the number of recurrent C. difficile infection episodes (0 rCDI, 1 rCDI, 2 rCDI, and 3+ rCDI). Results: In total, 46,571 patients with index C. difficile infection episode were included. During the 6-month pre-index, the mean (standard deviation) baseline Charlson comorbidity index score, by increasing the recurrent C. difficile infection group, was 1.2 (1.9), 1.5 (2.2), 1.8 (2.3), and 2.3 (2.5). During the 12-month follow-up, sepsis occurred in 16.5%, 27.3%, 33.1%, and 43.3% of patients, and subtotal colectomy or diverting loop ileostomy was performed in 4.6%, 7.3%, 8.9%, and 10.5% of patients, respectively, by increasing the recurrent C. difficile infection group. Conclusions: Reduction in recurrent C. difficile infection is an important step to reduce the burden of serious clinical complications, and new treatments are needed to reduce C. difficile infection recurrence.

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Section: Discussionmentioning

confidence: 99%

“… 23 In patients readmitted for rCDI after a major operating room procedure, there is average reimbursement gap of US $20,000. 18 …”

Section: Discussionmentioning

confidence: 99%

Clinical complications in patients with primary and recurrent Clostridioides difficile infection: A real-world data analysis

et al. 2021

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“…A survey of the State Inpatient Databases reported a LOS of 7.3 days for a primary rCDI diagnosis in U.S. adults. 30 Excess LOS attributable to CDI is approximately 3 days. 31 A previous analysis of Medicare claims data for patients with community-acquired CDI showed a median hospital LOS of 5 days (interquartile range, 3-8 days).…”

Section: Discussionmentioning

confidence: 99%

Health care resource utilization and costs of recurrent Clostridioides difficile infection in the elderly: a real-world claims analysis

Nelson

Scott

Boules

et al. 2021

JMCP

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BACKGROUND: Clostridioides difficile infection (CDI) affected an estimated 365,000 persons in the United States in 2017. Despite a nationally decreasing trend of CDI cases, the population incidence of recurrent CDI (rCDI) has not improved. Elderly individuals (aged ≥ 65 years) are at higher risk of CDI, rCDI, and complicated CDI compared with younger individuals. OBJECTIVE:To analyze Medicare fee-forservice data for 12 months after an initial CDI episode, in order to obtain real-world data on health care resource utilization (HRU) and costs for elderly patients with CDI and rCDI. METHODS:A retrospective cohort study of patients who were aged ≥ 65 years and had a first (index) CDI diagnosis from January 1, 2010, to December 31, 2016, and continuous enrollment in Medicare Parts A, B, and D during the 12-month pre-index and 12-month post-index periods was conducted. A CDI episode was identified by either an inpatient stay with CDI diagnosis code or an outpatient medical claim with a CDI diagnosis code plus a CDI treatment. Each CDI episode was followed by a 14-day CDI claim-free period after the last CDI claim or end of CDI treatment. rCDI was a second or subsequent episode of CDI that occurred within an 8-week window after the 14-day CDI claim-free period. The number of CDI and rCDI episodes, HRU, time to recurrence, and total all-cause direct medical costs were calculated over the 12-month pre-index (baseline) and 12-month follow-up periods and stratified by number of rCDI episodes (No rCDI, 1 rCDI, 2 rCDI, 3+ rCDI). RESULTS:A total of 268,762 patients with an index CDI were included. Mean age was 78.3 years, and 69.0% were female. HRU was higher during the 6 months immediately pre-index versus 7-12 months pre-index, including a higher proportion of patients with a hospital admission (55.1% vs. 27.5%) or emergency department visit (41.3% vs. 27.4%), respectively. Moreover, 34.7% of the study population experienced rCDI. Of those What is already known about this subjectaffects more than 350,000 individuals in the United States annually and confers substantial physical, social, and emotional burden to the patient.• The burden of recurrent CDI (rCDI) has not improved, despite a nationally decreasing trend of all CDI cases in recent years.• Elderly individuals are at higher risk than younger individuals for CDI, rCDI, and complicated CDI.

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“…Our findings are supported by other studies of readmissions in CDI that report rates of 25-30% readmission and prolonged duration of hospitalization. In a retrospective cohort study of 385,682 initial CDI hospitalizations identified between years 2009 and 2013 in the 4 states included in the State Inpatient Database (AHRQ), 25.7% of patients required readmission; among these, 36.8% had recurrent CDI as the principal diagnosis at the time of readmission [33]. A study of data from the Healthcare Cost and Utilization Project (HCUP) saw that patients with a primary or secondary diagnosis of CDI had a 30-day readmission rate of 29.1% [34].…”

Section: Discussionmentioning

confidence: 99%

Neighborhood disadvantage and 30-day readmission risk following Clostridioides difficile infection hospitalization

et al. 2020

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Background Clostridioides difficile infection (CDI) is commonly associated with outcomes like recurrence and readmission. The effect of social determinants of health, such as ‘neighborhood’ socioeconomic disadvantage, on a CDI patient’s health outcomes is unclear. Living in a disadvantaged neighborhood could interfere with a CDI patient’s ability to follow post-discharge care recommendations and the success probability of these recommendations, thereby increasing risk of readmission. We hypothesized that neighborhood disadvantage was associated with 30-day readmission risk in Medicare patients with CDI. Methods In this retrospective cohort study, odds of 30-day readmission for CDI patients are evaluated controlling for patient sociodemographics, comorbidities, and hospital and stay-level variables. The cohort was created from a random 20% national sample of Medicare patients during the first 11 months of 2014. Results From the cohort of 19,490 patients (39% male; 80% white; 83% 65 years or older), 22% were readmitted within 30 days of an index stay. Unadjusted analyses showed that patients from the most disadvantaged neighborhoods were readmitted at a higher rate than those from less disadvantaged neighborhoods (26% vs. 21% rate: unadjusted OR = 1.32 [1.20, 1.45]). This relationship held in adjusted analyses, in which residence in the most disadvantaged neighborhoods was associated with 16% increased odds of readmission (adjusted OR = 1.16 [1.04, 1.28]). Conclusions Residence in disadvantaged neighborhoods poses a significantly increased risk of readmission in CDI patients. Further research should focus on in-depth assessments of this population to better understand the mechanisms underlying these risks and if these findings apply to other infectious diseases.

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Hospital readmission with Clostridium difficile infection as a secondary diagnosis is associated with worsened outcomes and greater revenue loss relative to principal diagnosis

Abstract: Supplemental Digital Content is available in the text

Cited by 17 publications

References 18 publications

Clinical complications in patients with primary and recurrent Clostridioides difficile infection: A real-world data analysis

Clinical complications in patients with primary and recurrent Clostridioides difficile infection: A real-world data analysis

Health care resource utilization and costs of recurrent Clostridioides difficile infection in the elderly: a real-world claims analysis

Neighborhood disadvantage and 30-day readmission risk following Clostridioides difficile infection hospitalization

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