Cited by 25Clostridium difficile and Clostridium perfringens researchInfection Control in HealthcareHealthcare Quality and Management

Evaluating the Use of the Case Mix Index for Risk Adjustment of Healthcare-Associated Infection Data: An Illustration using Clostridium difficile Infection Data from the National Healthcare Safety Network

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Thompson, Nicola D., Edwards, Jonathan R., Dudeck, Margaret A., Fridkin, Scott K., Magill, Shelley S.·2016·Infection Control & Hospital Epidemiology

Abstract

BACKGROUND: Case mix index (CMI) has been used as a facility-level indicator of patient disease severity. We sought to evaluate the potential for CMI to be used for risk adjustment of National Healthcare Safety Network (NHSN) healthcare-associated infection (HAI) data. METHODS: NHSN facility-wide laboratory-identified Clostridium difficile infection event data from 2012 were merged with the fiscal year 2012 Inpatient Prospective Payment System (IPPS) Impact file by CMS certification number (CCN) to obtain a CMI value for hospitals reporting to NHSN. Negative binomial regression was used to evaluate whether CMI was significantly associated with healthcare facility-onset (HO) CDI in univariate and multivariate analysis. RESULTS: Among 1,468 acute care hospitals reporting CDI data to NHSN in 2012, 1,429 matched by CCN to a CMI value in the Impact file. CMI (median, 1.49; interquartile range, 1.36–1.66) was a significant predictor of HO CDI in univariate analysis (P<.0001). After controlling for community onset CDI prevalence rate, medical school affiliation, hospital size, and CDI test type use, CMI remained highly significant (P<.0001), with an increase of 0.1 point in CMI associated with a 3.4% increase in the HO CDI incidence rate. CONCLUSIONS: CMI was a significant predictor of NHSN HO CDI incidence. Additional work to explore the feasibility of using CMI for risk adjustment of NHSN data is necessary. Infect. Control Hosp. Epidemiol. 2015;37(1):19–25

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Authors
Thompson, N. D., Edwards, J. R., Dudeck, M. A., Fridkin, S. K., & Magill, S. S.
Affiliations
Centers for Disease Control and Prevention (US)
Corresponding author
Thompson, Nicola D.
Venue
Infection Control & Hospital Epidemiology
Published
2015-10-21
Volume
37
Issue
1
Pages
19-25
ISSN
  • 0899-823X (ISSN-L)
  • 1559-6834
OpenAlex
W2153570088
Cited by
25
References
23
Citations by year
2025: 1 · 2024: 1 · 2023: 1 · 2022: 2 · 2021: 4 · 2020: 5 · 2019: 1 · 2018: 5 · 2017: 4 · 2016: 1
FWCI
2.60
Type
journal article
Language
en
Open access
Locations
  • Infection Control and Hospital Epidemiology (publishedVersion)
  • PubMed (publishedVersion)
  • Europe PMC (PubMed Central) (acceptedVersion)
  • PubMed Central (acceptedVersion)
Funders
National Institutes of Health (CC999999)
Topics
  • Health Sciences › Medicine › Infectious Diseases › Clostridium difficile and Clostridium perfringens research
  • Health Sciences › Medicine › Infectious Diseases › Infection Control in Healthcare
  • Health Sciences › Health Professions › Health Information Management › Healthcare Quality and Management
Keywords
case mix index, risk adjustment, nosocomial infections, Clostridium difficile infection, National Healthcare Safety Network, Inpatient Prospective Payment System
MeSH terms
Clostridium Infections, Cross Infection, Hospitals, Humans, Predictive Value of Tests, United States, Incidence, Prevalence, Clostridioides difficile, Risk Adjustment

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