The Likelihood of Hospital Readmissions Based on Exposure to Central Line-Associated Bloodstream Infection 公开

Abstract

Research on healthcare-associated infections suggests a potential association with hospital readmissions. A secondary data analysis was conducted on a retrospective matched cohort study to determine if there was an association between central line-associated bloodstream infection (CLABSI) status during the index hospitalization and later re-hospitalization. Readmission was measured from the patient's index discharge to the following 30 days via logistic regression analysis and as the first hospitalization following index discharge, regardless of timing, via survival analysis. The final logistic regression model determined a statistically significant association between CLABSI status and readmission, with effect modifiers length of stay and rheumatoid arthritis. The odds of readmission were 1.59 times more likely among CLABSI patients with rheumatoid arthritis than those without rheumatoid arthritis, for a median length of stay between 13 and 22 days [OR=1.588, 95% CI (1.030, 2.447)]. The odds ratio for the shortest length of stay between zero and six days was 11.17 for patients without rheumatoid arthritis [OR=11.172, 95% CI (2.307, 54.093)]. Similarly, the final stratified Cox model determined a statistically significant association between CLABSI status and readmission, with effect modifiers length of stay, rheumatoid arthritis, depression, and chronic kidney disease. The hazard of readmission was 1.59 times more likely among CLABSI patients with rheumatoid arthritis than those without rheumatoid arthritis, for a median length of stay between 13 and 22 days [HR=1.589, 95% CI (1.228, 2.056)]. The hazard ratio for the shortest length of stay between zero and six days was 3.09 for patients without rheumatoid arthritis, depression, or chronic kidney disease [HR=3.093, 95% CI (1.647, 5.808)]. Both the adjusted odds and hazard ratios for the effect of CLABSI on readmission decreased as length of stay increased, given fixed rheumatoid arthritis status. Also, both the adjusted odds and hazard ratios were higher for patients diagnosed with rheumatoid arthritis than for patients not diagnosed with rheumatoid arthritis, for a fixed length of stay. The adjusted logistic regression and survival analyses resulted in a statistically significant association between CLABSI status and readmission. These findings suggest that a focus on the prevention of CLABSIs could reduce re-hospitalizations, improving patient safety and public health.

Table of Contents

Introduction................................................................................................ 1

Methods...................................................................................................... 8

Results...................................................................................................... 19

Discussion................................................................................................. 27

References................................................................................................ 37

Tables........................................................................................................ 41

Figures...................................................................................................... 67

Appendix .................................................................................................. 69

About this Master's Thesis

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School	Rollins School of Public Health
Department	Epidemiology
Degree	MPH
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Public Health
关键词	healthcare-associated infection hospital readmission central line-associated bloodstream infection
Committee Chair / Thesis Advisor	Kleinbaum, David, Emory University
Committee Members	Baggs, James, Centers for Disease Control and Prevention Cochran, Ronda, Centers for Disease Control and Prevention
Partnering Agencies	CDC

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