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Substantial Shifts in Ranking of California Hospitals by Hospital-Associated Methicillin-Resistant Staphylococcus aureus Infection Following Adjustment for Hospital Characteristics and Case Mix

Published online by Cambridge University Press:  10 May 2016

David M. Tehrani ,
Michael J. Phelan ,
Chenghua Cao ,
John Billimek ,
Rupak Datta ,
Hoanglong Nguyen ,
Homin Kwark  and
Susan S. Huang
David M. Tehrani*
Affiliation:
Division of Infectious Disease and Health Policy Research Institute, University of California Irvine School of Medicine, Irvine, California Health Policy Research Institute, University of California Irvine School of Medicine, Irvine, California
Michael J. Phelan
Affiliation:
Department of Statistics, University of California Irvine, Irvine, California
Chenghua Cao
Affiliation:
Division of Infectious Disease and Health Policy Research Institute, University of California Irvine School of Medicine, Irvine, California Health Policy Research Institute, University of California Irvine School of Medicine, Irvine, California
John Billimek
Affiliation:
Health Policy Research Institute, University of California Irvine School of Medicine, Irvine, California
Rupak Datta
Affiliation:
Division of Infectious Disease and Health Policy Research Institute, University of California Irvine School of Medicine, Irvine, California Health Policy Research Institute, University of California Irvine School of Medicine, Irvine, California
Hoanglong Nguyen
Affiliation:
Division of Infectious Disease and Health Policy Research Institute, University of California Irvine School of Medicine, Irvine, California Health Policy Research Institute, University of California Irvine School of Medicine, Irvine, California
Homin Kwark
Affiliation:
Division of Infectious Disease and Health Policy Research Institute, University of California Irvine School of Medicine, Irvine, California Health Policy Research Institute, University of California Irvine School of Medicine, Irvine, California
Susan S. Huang
Affiliation:
Division of Infectious Disease and Health Policy Research Institute, University of California Irvine School of Medicine, Irvine, California Health Policy Research Institute, University of California Irvine School of Medicine, Irvine, California
*
Division of Infectious Diseases and Health Policy Research Institute, University of California Irvine School of Medicine, 100 Theory Drive, Suite 110, Irvine, CA 92617 (tehranid@uci.edu).
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Abstract

Background.

States have established public reporting of hospital-associated (HA) infections—including those of methicillin-resistant Staphylococcus aureus (MRSA)—but do not account for hospital case mix or postdischarge events

Objective.

Identify facility-level characteristics associated with HA-MRSA infection admissions and create adjusted hospital rankings.

Methods.

A retrospective cohort study of 2009–2010 California acute care hospitals. We defined HA-MRSA admissions as involving MRSA pneumonia or septicemia events arising during hospitalization or within 30 days after discharge. We used mandatory hospitalization and US Census data sets to generate hospital population characteristics by summarizing across admissions. Facility-level factors associated with hospitals’ proportions of HA-MRSA infection admissions were identified using generalized linear models. Using state methodology, hospitals were categorized into 3 tiers of HA-MRSA infection prevention performance, using raw and adjusted values.

Results.

Among 323 hospitals, a median of 16 HA-MRSA infections (range, 0–102) per 10,000 admissions was found. Hospitals serving a greater proportion of patients who had serious comorbidities, were from low-education zip codes, and were discharged to locations other than home were associated with higher HA-MRSA infection risk. Total concordance between all raw and adjusted hospital rankings was 0.45 (95% confidence interval, 0.40–0.51). Among 53 community hospitals in the poor-performance category, more than 20% moved into the average-performance category after adjustment. Similarly, among 71 hospitals in the superior-performance category, half moved into the average-performance category after adjustment.

Conclusions.

When adjusting for nonmodifiable facility characteristics and case mix, hospital rankings based on HA-MRSA infections substantially changed. Quality indicators for hospitals require adequate adjustment for patient population characteristics for valid interhospital performance comparisons.

Infect Control Hosp Epidemiol 2014;35(10):1263–1270

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 35 , Issue 10 , October 2014 , pp. 1263 - 1270
Copyright
© 2014 by The Society for Healthcare Epidemiology of America. All rights reserved.

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