This study uses cross-sectional analysis of huge Medicare hospital discharge databases to test the hypothesis that hospitals with longer inpatient average lengths of stay (ALOS) will have higher healthcare-associated infection (HAI) rates. For 4 carefully defined and important procedures, the authors investigated the relationship between a hospital's HAI rate and the ALOS for patients who did not have such an infection. The authors found a strong positive correlation between the 2 measures. This finding has important implications for improving patient safety and controlling cost. This article offers hypotheses on the causality of the ALOS-infection rate correlation and suggests ways to test those hypotheses.
Weinstein R. Nosocomial infection update. Emerg Infect Dis. 1998;4(31):416-420.
2.
Centers for Disease Control and Prevention (CDC). Public Health Focus: Surveillance, Prevention, and Control of Nosocomial Infections. Morb Mortal Wkly Rep1992;42(42):783-787.
3.
Centers for Disease Control and Prevention (CDC), Division of Media Relations. 2000. Hospital infections cost U.S. billions of dollars annually. Available at: www.cdc.gov/. Accessed April 30, 2003.
4.
Centers for Medicare & Medicaid Services (CMS). Expanded Modified MEDPAR National Data, 1999, 2000, 2001. Available at: www.cms.hhs.gov/statistics/medpar/default.asp. Accessed March 9, 2004.
5.
International Classification of Disease. 9th ed.Clinical Modification, Medicode. Dover, Del: American Medical Association; 1996.
Burke J. Infection control-a problem for patient safety. N Engl J Med. 2003;348(7)651-656.
8.
SAS Institute Inc.PROC GENMOD. Version 8.0. Cary, NC: SAS Institute Inc; 1999.
9.
Roman P, Geppert J, Davies S, et al.A national profile of patient safety in US hospitals. Health Aff2003;March/April.
10.
Morrss SD, Garg PP, Nyberg D, et al.Are critical pathways effective for reducing postoperative length of stay?Med Care. 2003;41(5):637-648.
11.
Roberts R, Scott RD, Cordell R, et al.The use of economic modeling to determine the hospital costs associated with nosocomial infections. Clin Infect Dis2003: June(36)1424-1432.
12.
Dulworth S. Exploiting the overlap: using utilization management to reduce medical malpractice. Am J Med Qual. 2003; 18(3)128-132.
13.
Wennberg JE, Cooper MM, eds. The Quality of Medical Care in the United States: A Report on the Medicare Program, The Dartmouth Atlas of Health Care. Chicago: American Health Association Press; 1999.
14.
Centers for Disease Control and Prevention. National Nosocomial Infections Surveillance (NNIS) System Report [January 1992 to June 2002]. Centers for Disease Control and Prevention; 2002.
15.
Lawthers AG, McCarthy EP, David RB, et al.Identification of in-hospital complications from claims data. Is it valid?Med Care. 2000;38(8):785-795.
16.
Weingart SN, Iezzoni LI, Davis RB, et al.Use of administrative data to find substandard care-validation of the complications screening program. Med Care. 2000;38(8):796-806.
17.
Milliman USA. 2004. Health Efficiency Index. Available at: www.milliman.com/health/tools-and-models/hospitaLefficiency.index.asp. Accessed March 9, 2004.
