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A Generalizable, Data-Driven Approach to Predict Daily Risk of Clostridium difficile Infection at Two Large Academic Health Centers

  • Jeeheh Oh (a1), Maggie Makar (a2), Christopher Fusco (a3), Robert McCaffrey (a3), Krishna Rao (a4), Erin E. Ryan (a5) (a6), Laraine Washer (a4) (a7), Lauren R. West (a5) (a6), Vincent B. Young (a4) (a8), John Guttag (a2), David C. Hooper (a5) (a6) (a9), Erica S. Shenoy (a5) (a6) (a9) (a10) and Jenna Wiens (a1)...

An estimated 293,300 healthcare-associated cases of Clostridium difficile infection (CDI) occur annually in the United States. To date, research has focused on developing risk prediction models for CDI that work well across institutions. However, this one-size-fits-all approach ignores important hospital-specific factors. We focus on a generalizable method for building facility-specific models. We demonstrate the applicability of the approach using electronic health records (EHR) from the University of Michigan Hospitals (UM) and the Massachusetts General Hospital (MGH).


We utilized EHR data from 191,014 adult admissions to UM and 65,718 adult admissions to MGH. We extracted patient demographics, admission details, patient history, and daily hospitalization details, resulting in 4,836 features from patients at UM and 1,837 from patients at MGH. We used L2 regularized logistic regression to learn the models, and we measured the discriminative performance of the models on held-out data from each hospital.


Using the UM and MGH test data, the models achieved area under the receiver operating characteristic curve (AUROC) values of 0.82 (95% confidence interval [CI], 0.80–0.84) and 0.75 ( 95% CI, 0.73–0.78), respectively. Some predictive factors were shared between the 2 models, but many of the top predictive factors differed between facilities.


A data-driven approach to building models for estimating daily patient risk for CDI was used to build institution-specific models at 2 large hospitals with different patient populations and EHR systems. In contrast to traditional approaches that focus on developing models that apply across hospitals, our generalizable approach yields risk-stratification models tailored to an institution. These hospital-specific models allow for earlier and more accurate identification of high-risk patients and better targeting of infection prevention strategies.

Infect Control Hosp Epidemiol 2018;39:425–433

Corresponding author
Address correspondence to Jenna Wiens, PhD, 2260 Hayward Street, Ann Arbor, MI 48109 ( or Erica S. Shenoy, MD, PhD, 55 Fruit Street, Bulfinch 334, Boston, MA (
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Infection Control & Hospital Epidemiology
  • ISSN: 0899-823X
  • EISSN: 1559-6834
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