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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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1 2016
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Source: Infect Control Hosp Epidemiol. 37(1):19-25
[PDF-239.22 KB]
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Alternative Title:Infect Control Hosp Epidemiol
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Description: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.
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Pubmed ID:26486597
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Pubmed Central ID:PMC6498436
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