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
Open accessAbstract
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
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
Hospital operation managers may review quarterly or even monthly DRG-based statistics to assess patient mix and financial efficiency under DRG reimbursement.
“Hospital operation managers may review quarterly or even monthly DRG-based statistics to assess its patient mix3,4 and financial efficiency5,6 under DRG reimbursement.”
From Early prediction of diagnostic-related groups and estimation of hospital cost by processing clinical notes (2021) · cites this paper as [4]
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
The self-check needs the paper’s full text.
Cites
Negative Binomial Regression: Index
Hilbe, J. (2007) · Cambridge University Press eBooks · doi:10.1017/cbo9780511973420 · Cited by 3,253 · see citing works
Hilbe, J. M. (2007) · Cambridge University Press eBooks · doi:10.1017/cbo9780511811852.007 · Cited by 1,998 · see citing works
National Healthcare Safety Network (NHSN) report, data summary for 2012, Device-associated module
Dudeck, M. A., Weiner, L. M., Allen‐Bridson, K., Malpiedi, P. J., Peterson, K. D., Pollock, D. A., Sievert, D. M., & Edwards, J. R. (2013) · American Journal of Infection Control · doi:10.1016/j.ajic.2013.09.002 · Cited by 657 · see citing works
Self-citationMu, Y., Edwards, J. R., Horan, T. C., Berríos-Torres, S. I., & Fridkin, S. K. (2011) · Infection Control and Hospital Epidemiology · doi:10.1086/662016 · Cited by 390 · see citing works
Self-citationMcKibben, L., Horan, T. C., Tokars, J. I., Fowler, G. L., Cardo, D. M., Pearson, M. L., & Brennan, P. J. (2005) · Infection Control and Hospital Epidemiology · doi:10.1086/502585 · Cited by 255 · see citing works
McKibben, L., HORAN, T., Tokars, J. I., Fowler, G. L., Cardo, D. M., Pearson, M. L., & BRENNAN, P. (2005) · American Journal of Infection Control · doi:10.1016/j.ajic.2005.04.001 · Cited by 220 · see citing works
Benchmarking Risk-Adjusted Adult Antibacterial Drug Use in 70 US Academic Medical Center Hospitals
Polk, R. E., Hohmann, S. F., Medvedev, S., & Ibrahim, O. M. (2011) · Clinical Infectious Diseases · doi:10.1093/cid/cir672 · Cited by 144 · see citing works
Impact of Hospital Variables on Case Mix Index as a Marker of Disease Severity
Mendez, C. M., Harrington, D. W., Christenson, P., & Spellberg, B. (2014) · Population Health Management · doi:10.1089/pop.2013.0002 · Cited by 130 · see citing works
Munoz-Price, L. S., Hota, B. N., Stemer, A., & Weinstein, R. A. (2009) · Infection Control and Hospital Epidemiology · doi:10.1086/644751 · Cited by 126 · see citing works
Hospital Case-Mix Change: Sicker Patients Or Drg Creep?
Steinwald, B., & Dummit, L. A. (1989) · Health Affairs · doi:10.1377/hlthaff.8.2.35 · Cited by 105 · see citing works
Interhospital Differences in Nosocomial Infection Rates Importance of Case-Mix Adjustment
Sax, H. (2002) · Archives of Internal Medicine · doi:10.1001/archinte.162.21.2437 · Cited by 100 · see citing works
Correlation between case mix index and antibiotic use in hospitals
Kuster, S. P., Ruef, C., Bollinger, A. K., Ledergerber, B., Hintermann, A., Deplazes, C., Neuber, L., & Weber, R. (2008) · Journal of Antimicrobial Chemotherapy · doi:10.1093/jac/dkn275 · Cited by 90 · see citing works
Iezzoni, L. I. (1994) · The Annals of Thoracic Surgery · doi:10.1016/0003-4975(94)91721-3 · Cited by 86 · see citing works
Quality Measures and Sociodemographic Risk Factors
Fiscella, K. A., Burstin, H. R., & Nerenz, D. R. (2014) · JAMA · doi:10.1001/jama.2014.15372 · Cited by 72 · see citing works
Anderson, D. J., Chen, L. F., Sexton, D. J., & Kaye, K. S. (2008) · Infection Control and Hospital Epidemiology · doi:10.1086/591457 · Cited by 61 · see citing works
The Risks of Not Adjusting Performance Measures for Sociodemographic Factors
Lipstein, S. H., & Dunagan, W. C. (2014) · Annals of Internal Medicine · doi:10.7326/m14-1601 · Cited by 32 · see citing works
Rosenbaum, B. P., Lorenz, R. R., Luther, R. B., Knowles-Ward, L., Kelly, D. L., & Weil, R. J. (2014) · PubMed Central · Cited by 31 · see citing works
Feasibility and validity of International Classification of Diseases based case mix indices
Yang, C.-M., & Reinke, W. A. (2006) · BMC Health Services Research · doi:10.1186/1472-6963-6-125 · Cited by 28 · see citing works
All patient refined-diagnostic related group and case mix index in acute care palliative medicine.
Lagman, R. L., Walsh, D., Davis, M. P., & Young, B. (2007) · PubMed · Cited by 23 · see citing works
Haley, V. B., DiRienzo, A. G., Lutterloh, E. C., & Stricof, R. L. (2013) · Infection Control and Hospital Epidemiology · doi:10.1086/674389 · Cited by 20 · see citing works
Tong, E. N. C., Clements, A., Haynes, M. A., Jones, M., Morton, A., & Whitby, M. (2009) · BMC Infectious Diseases · doi:10.1186/1471-2334-9-145 · Cited by 17 · see citing works
The Need for Advancements in the Field of Risk Adjustment for Healthcare-Associated Infections
McGregor, J. C., & Harris, A. D. (2013) · Infection Control and Hospital Epidemiology · doi:10.1086/674412 · Cited by 10 · see citing works
Tehrani, D. M., Phelan, M. J., Cao, C., Billimek, J., Datta, R., Nguyen, H., Kwark, H., & Huang, S. S. (2014) · Infection Control and Hospital Epidemiology · doi:10.1086/678069 · Cited by 7 · see citing works
Flagged first, then by citations
Cited by
Sorted by citations
McDonald, L. C., Gerding, D. N., Johnson, S., Bakken, J. S., Carroll, K. C., Coffin, S. E., Dubberke, E. R., Garey, K. W., Gould, C. V., Kelly, C., et al. (2018) · Clinical Infectious Diseases · doi:10.1093/cid/cix1085 · Cited by 2,690 · see citing works
Incidence and Outcomes Associated With Clostridium difficile Infections
Marra, A. R., Perencevich, E. N., Nelson, R. E., Samore, M. H., Khader, K., Chiang, H., Chorazy, M. L., Herwaldt, L. A., Diekema, D. J., Kuxhausen, M., et al. (2020) · JAMA Network Open · doi:10.1001/jamanetworkopen.2019.17597 · Cited by 139 · see citing works
Asrani, S. K., Kouznetsova, M., Ogola, G., Taylor, T. J., Masica, A. L., Pope, B., Trotter, J. F., Kamath, P. S., & Kanwal, F. (2018) · Gastroenterology · doi:10.1053/j.gastro.2018.05.032 · Cited by 122 · see citing works
Kazakova, S. V., Baggs, J. M., McDonald, L. C., Yi, S. H., Hatfield, K. M., Guh, A. Y., Reddy, S. C., & Jernigan, J. A. (2019) · Clinical Infectious Diseases · doi:10.1093/cid/ciz169 · Cited by 81 · see citing works
Liu, J., Capurro, D., Nguyen, A., & Verspoor, K. (2021) · npj Digital Medicine · doi:10.1038/s41746-021-00474-9 · Cited by 50 · see citing works
Declines in the utilization of hospital‐based care during COVID‐19 pandemic
Kazakova, S. V., Baggs, J. M., Parra, G., Yusuf, H. R., Romano, S. D., Ko, J. Y., Harris, A. M., Wolford, H. M., Rose, A. N., Reddy, S. C., et al. (2022) · Journal of Hospital Medicine · doi:10.1002/jhm.12955 · Cited by 28 · see citing works
Harris, A. D., Sbarra, A. N., Leekha, S., Jackson, S. S., Johnson, J. K., Pineles, L. L., & Thom, K. A. (2018) · Infection Control and Hospital Epidemiology · doi:10.1017/ice.2018.10 · Cited by 20 · see citing works
Carling, P., O’Hara, L. M., Harris, A. D., & Olmsted, R. N. (2022) · Infection Control and Hospital Epidemiology · doi:10.1017/ice.2022.84 · Cited by 17 · see citing works
Pakyz, A. L., Wang, H., Özcan, Y. A., Edmond, M. B., & Vogus, T. J. (2017) · Journal of Patient Safety · doi:10.1097/pts.0000000000000378 · Cited by 16 · see citing works
Marra, A. R., Alzunitan, M. A., Abosi, O. J., Edmond, M. B., Street, W. N., Cromwell, J. W., & Salinas, J. L. (2020) · Diagnostic Microbiology and Infectious Disease · doi:10.1016/j.diagmicrobio.2020.115104 · Cited by 14 · see citing works
Miller, A. C., Sewell, D. K., Segre, A. M., Pemmaraju, S. V., & Polgreen, P. M. (2020) · The Journal of Infectious Diseases · doi:10.1093/infdis/jiaa773 · Cited by 14 · see citing works
Rethinking standardised infection rates and risk adjustment in the COVID-19 era
Salmasian, H., Beloff, J., Resnick, A. S., Rhee, C., Baker, M. A., Klompas, M., & Pimentel, M. P. T. (2021) · BMJ Quality & Safety · doi:10.1136/bmjqs-2020-012074 · Cited by 9 · see citing works
Goodenough, D., Sefton, S., Overton, E. C., Smith, E., Kraft, C. S., Varkey, J. B., & Fridkin, S. K. (2021) · Infection Control and Hospital Epidemiology · doi:10.1017/ice.2021.145 · Cited by 6 · see citing works
Self-citationBarlow, G., Patterson, J. A., Stultz, J. S., & Pakyz, A. L. (2017) · American Journal of Infection Control · doi:10.1016/j.ajic.2017.06.022 · Cited by 5 · see citing works
Pellegrin, K. L., Lozano, A. J., Miyamura, J., Lynn, J., Krenk, L., Jolson-Oakes, S., Ciarleglio, A. E., McInnis, T., Bairos, A. W., Gomez, L., et al. (2018) · BMJ Quality & Safety · doi:10.1136/bmjqs-2018-008418 · Cited by 5 · see citing works
Nurse Work Environment and Hospital-Onset Clostridioides difficile Infection
Jung, O., Aiken, L. H., Sloane, D. M., Fridkin, S. K., Li, Y., Kang, Y. J., Becker, E. R., Joski, P. J., & Cimiotti, J. P. (2023) · Medical Care · doi:10.1097/mlr.0000000000001854 · Cited by 4 · see citing works
Self-citationAssociation Between High-Risk Medication Usage and Healthcare Facility-Onset C. difficile Infection
Patterson, J. A., Edmond, M. B., Hohmann, S. F., & Pakyz, A. L. (2016) · Infection Control and Hospital Epidemiology · doi:10.1017/ice.2016.87 · Cited by 4 · see citing works
Understanding physician antibiotic prescribing behavior for children with enterovirus infection
Kuo, K.-C., Yeh, Y., Huang, Y., Chen, I., & Lee, C. (2018) · PLoS ONE · doi:10.1371/journal.pone.0202316 · Cited by 4 · see citing works
Polage, C. R., Quan, K. A., Madey, K. M., Myers, F. E., Wightman, D. A., Krishna, S., Grein, J. D., Gibbs, L., Yokoe, D. S., Mabalot, S. C., et al. (2020) · Infection Control and Hospital Epidemiology · doi:10.1017/ice.2020.4 · Cited by 4 · see citing works
Controversies in Healthcare-Associated Infection Surveillance
Sood, G., & Leekha, S. (2017) · Springer eBooks · doi:10.1007/978-3-319-60980-5_28 · Cited by 2 · see citing works
Kozlov, R. S., Shelygin, Y. A., Veselov, A. V., Dekhnich, A. V., Zubareva, N., Ershova, O. N., Кулабухов, В. В., Попов, Д. А., Reshedko, G., & Yakushin, S. B. (2018) · Clinical Microbiology and Antimicrobial Chemotherapy · doi:10.36488/cmac.2018.2.76-124 · Cited by 2 · see citing works
Cook, C. B., Thompson, B., Perrin, A. J., Castro, J. C., McGary, A. K., & Buras, M. R. (2025) · Endocrine Practice · doi:10.1016/j.eprac.2025.09.200 · Cited by 1 · see citing works
Aguilera, J. C. G., Belizón, Y. E. V., Ortíz, A. A., & Lavernia, J. O. C. (2020) · DOAJ (DOAJ: Directory of Open Access Journals)
Valentine, J. C., Hall, L., Verspoor, K. M., Gillespie, E. E., & Worth, L. J. (2021) · Internal Medicine Journal · doi:10.1111/imj.15301
Corneliusson, L., Ruotsalainen, S., Pesonen, T., Sulander, J., & Sinervo, T. S. (2024) · Health & Social Care in the Community · doi:10.1155/2024/9994777
- 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
- Publisher
- Cambridge University Press (CUP)
- Published
- 2015-10-21
- Volume
- 37
- Issue
- 1
- Pages
- 19-25
- ISSN
- 0899-823X (ISSN-L)
- 1559-6834
- PMC
- PMC6498436
- 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
- green
- www.ncbi.nlm.nih.gov
- 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
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review