Morrison GC (Dept Economics, IUPUI; Regenstrief Institute, Inc; and HSR&D CoE in Implementing Evidence-based Practice)
McCoy K (HSR&D CoE in Implementing Evidence-based practice, Indianapolis VA Medical Center)
Doebbeling BN (HSR&D CoE in Implementing Evidence-based Practice, Indianapolis VA Medical Center, Regenstrief Institute Inc, and Dept Medicine, Indiana U Med School)
for the AMR Evidence-based Study Group
With hospitals facing increasing pressure to contain, or even reduce, the costs of providing health care, it is important to identify characteristics, structures and processes associated with lower (or higher) hospital costs. We sought to determine whether AMR levels and outbreaks in hospitals are significantly related to hospital level expenses-per-admission. Further, we sought to identify measures of AMR control associated with lower hospital expenses.
A nationally representative sample of 670 hospitals (stratified by bedsize, teaching status, geographic region, and VA vs. non-VA) were surveyed regarding recommended guidelines to prevent and control AMR, availability of information technology (IT), and hospital culture. Surveys of the lead infection control professional, lab director, and most recent antibiogram (levels of resistance) were collected. Survey data was linked to the AHA Annual Survey, to incorporate other hospital level financial and operational capacity characteristics. Survey data were validated by comparison with antibiogram reports. We examined correlations between hospital expenses-per-admission and 15 structure and process measures recommended for AMR control.
A total of 448 of the 670 (67%) hospitals participated. Hospitals with higher levels of oxacillin-resistant S. aureus (ORSA) and higher levels of vancomycin-resistant Enterococcus sp. (VRE) had greater total expenses-per-admission (p=0.07 and p=0.02, respectively). Higher hospital expenses-per-admission were associated with more recent outbreaks of ORSA (p<0.01), VRE (p=0.08), and ceftazidime-resistant Klebsiella sp. (p<0.05). Three prevention and control measures were significantly associated with lower total hospital expenses-per-admission: 1) greater use of antiseptic handcleansing agents; 2) appropriately identifying hospitalized patients colonized with clinically-important AMR microorganisms; and 3) creating or revising forms to support adherence to infection control policies.
Higher levels of clinically significant AMR organisms and more recent outbreaks due to them are associated with higher hospital expenses-per-admission. Only three guideline recommended measures emerged as being associated with lower expenses-per-admission: identifying colonized patients, enhancing hand hygiene and creating forms to enhance adherence.
Increased implementation of three guideline recommended AMR control measures (identifying colonized patients, enhancing hand hygiene and creating forms to enhance adherence) in a national sample of VA and non-VA hospitals is potentially cost saving. Further study is needed to test interventions based on these findings.