The Impact of Healthcare-Associated Methicillin-Resistant Staphylococcus aureus Infections on Postdischarge Health Care Costs and Utilization across Multiple Health Care Systems
Corresponding Author
Richard E. Nelson Ph.D.
Veterans Affairs Salt Lake City Health Care System, Salt Lake City, UT
Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT
Address correspondence to Richard E. Nelson, Ph.D., Veterans Affairs Salt Lake City Health Care System, 500 Foothill Blvd, Salt Lake City, UT 84148; and also Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT; e-mail: [email protected].Search for more papers by this authorMakoto Jones M.D.
Veterans Affairs Salt Lake City Health Care System, Salt Lake City, UT
Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT
Search for more papers by this authorChuan-Fen Liu Ph.D., M.P.H.
Veterans Affairs Puget Sound Health Care System, Seattle, WA
Department of Health Services, University of Washington, Seattle, WA
Search for more papers by this authorMatthew H. Samore M.D.
Veterans Affairs Salt Lake City Health Care System, Salt Lake City, UT
Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT
Search for more papers by this authorMartin E. Evans M.D.
Lexington Veterans Affairs Medical Center, Lexington, KY
MRSA/MDRO Program, National Infectious Diseases Service, Veterans Health Administration, Lexington, KY
Department of Internal Medicine, University of Kentucky, Lexington, KY
Search for more papers by this authorVanessa W. Stevens Ph.D.
Veterans Affairs Salt Lake City Health Care System, Salt Lake City, UT
Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT
Search for more papers by this authorThomas Reese Pharm.D.
Department of Biomedical Informatics, University of Utah School of Medicine, Salt Lake City, UT
Search for more papers by this authorMichael A. Rubin M.D., Ph.D.
Veterans Affairs Salt Lake City Health Care System, Salt Lake City, UT
Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT
Search for more papers by this authorCorresponding Author
Richard E. Nelson Ph.D.
Veterans Affairs Salt Lake City Health Care System, Salt Lake City, UT
Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT
Address correspondence to Richard E. Nelson, Ph.D., Veterans Affairs Salt Lake City Health Care System, 500 Foothill Blvd, Salt Lake City, UT 84148; and also Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT; e-mail: [email protected].Search for more papers by this authorMakoto Jones M.D.
Veterans Affairs Salt Lake City Health Care System, Salt Lake City, UT
Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT
Search for more papers by this authorChuan-Fen Liu Ph.D., M.P.H.
Veterans Affairs Puget Sound Health Care System, Seattle, WA
Department of Health Services, University of Washington, Seattle, WA
Search for more papers by this authorMatthew H. Samore M.D.
Veterans Affairs Salt Lake City Health Care System, Salt Lake City, UT
Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT
Search for more papers by this authorMartin E. Evans M.D.
Lexington Veterans Affairs Medical Center, Lexington, KY
MRSA/MDRO Program, National Infectious Diseases Service, Veterans Health Administration, Lexington, KY
Department of Internal Medicine, University of Kentucky, Lexington, KY
Search for more papers by this authorVanessa W. Stevens Ph.D.
Veterans Affairs Salt Lake City Health Care System, Salt Lake City, UT
Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT
Search for more papers by this authorThomas Reese Pharm.D.
Department of Biomedical Informatics, University of Utah School of Medicine, Salt Lake City, UT
Search for more papers by this authorMichael A. Rubin M.D., Ph.D.
Veterans Affairs Salt Lake City Health Care System, Salt Lake City, UT
Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT
Search for more papers by this authorAbstract
Objective
To measure how much of the postdischarge cost and utilization attributable to methicillin-resistant Staphylococcus aureus (MRSA) health care-associated infections (HAIs) occur within the US Department of Veterans Affairs (VA) system and how much occurs outside.
Data Sources/Study Setting
Health care encounters from 3 different settings and payment models: (1) within the VA; (2) outside the VA but paid for by the VA (purchased care); and (3) outside the VA and paid for by Medicare.
Study Design
Historical cohort study using data from admissions to VA hospitals between 2007 and 2012.
Methods
We assessed the impact of a positive MRSA test result on costs and utilization during the 365 days following discharge using inverse probability of treatment weights to balance covariates.
Principal Findings
Among a cohort of 152,687 hospitalized Veterans, a positive MRSA test result was associated with an overall increase of 6.6 (95 percent CI: 5.7–7.5) inpatient days and $9,237 (95 percent CI: $8,211–$10,262) during the postdischarge period. VA inpatient admissions, Medicare reimbursements, and purchased care payments accounted for 60.6 percent, 22.5 percent, and 16.9 percent of these inpatient costs.
Conclusions
While most of the excess postdischarge health care costs associated with MRSA HAIs occurred in the VA, non-VA costs make up an important subset of the overall burden.
Supporting Information
| Filename | Description |
|---|---|
| hesr13063-sup-0001-AppendixSA1.pdfPDF document, 1.5 MB | Appendix SA1: Author Matrix. |
| hesr13063-sup-0002-SupInfo.docxWord document, 110.4 KB |
Figure S1: Cohort Selection Diagram. Table S1: Impact of MRSA Culture on VA, Medicare, and Purchased Care Cost Outcomes During 365-day Post-Discharge Period. Table S2: Impact of MRSA Culture on VA, Medicare, and Purchased Care Utilization Outcomes During 365-day Post-Discharge Period. |
Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.
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