title: The impact of healthcare-associated methicillin-resistant Staphylococcus aureus infections on post-discharge healthcare costs and utilization.
abstract: OBJECTIVE
  Healthcare-associated methicillin-resistant Staphylococcus aureus (MRSA) infections are a major cause of morbidity, mortality, and cost among hospitalized patients. Little is known about their impact on post-discharge resource utilization. The purpose of this study was to estimate post-discharge healthcare costs and utilization attributable to positive MRSA cultures during a hospitalization.
  
  
  METHODS
  Our study cohort consisted of patients with an inpatient admission lasting longer than 48 hours within the US Department of Veterans Affairs (VA) system between October 1, 2007, and November 30, 2010. Of these patients, we identified those with a positive MRSA culture from microbiology reports in the VA electronic medical record. We used propensity score matching and multivariable regression models to assess the impact of positive culture on post-discharge outpatient, inpatient, and pharmacy costs and utilization in the 365 days following discharge.
  
  
  RESULTS
  Our full cohort included 369,743 inpatients, of whom, 3,599 (1.0%) had positive MRSA cultures. Our final analysis sample included 3,592 matched patients with and without positive cultures. We found that, in the 12 months following hospital discharge, having a positive culture resulted in increases in post-discharge pharmacy costs ($776, P<.0001) and inpatient costs ($12,167, P<.0001). Likewise, having a positive culture increased the risk of a readmission (odds ratio [OR]=1.396, P<.0001), the number of prescriptions (incidence rate ratio [IRR], 1.138; P<.0001) and the number of inpatient days (IRR, 1.204; P<.0001,) but decreased the number of subsequent outpatient encounters (IRR, 0.941; P<.008).
  
  
  CONCLUSIONS
  The results of this study indicate that MRSA infections are associated with higher levels of post-discharge healthcare cost and utilization. These findings indicate that financial benefits resulting from infection prevention efforts may extend beyond the initial hospital stay.
authors.affiliation: 1Veterans Affairs Salt Lake City Health Care System,Salt Lake City,Utah.
authors.forename: Richard E
authors.initials: RE
authors.lastname: Nelson
authors.affiliation: 1Veterans Affairs Salt Lake City Health Care System,Salt Lake City,Utah.
authors.forename: Makoto
authors.initials: M
authors.lastname: Jones
authors.affiliation: 3Veterans Affairs Puget Sound Health Care System,Seattle,Washington.
authors.forename: Chuan-Fen
authors.initials: CF
authors.lastname: Liu
authors.affiliation: 1Veterans Affairs Salt Lake City Health Care System,Salt Lake City,Utah.
authors.forename: Matthew H
authors.initials: MH
authors.lastname: Samore
authors.affiliation: 5Lexington Veterans Affairs Medical Center,Lexington,Kentucky.
authors.forename: Martin E
authors.initials: ME
authors.lastname: Evans
authors.affiliation: 8School of Public Health and Institute for Health & Biomedical Innovation,Queensland University of Technology,Brisbane,Australia.
authors.forename: Nicholas
authors.initials: N
authors.lastname: Graves
authors.affiliation: 9Department of International Health,Johns Hopkins University,Baltimore,Maryland.
authors.forename: Bruce
authors.initials: B
authors.lastname: Lee
authors.affiliation: 1Veterans Affairs Salt Lake City Health Care System,Salt Lake City,Utah.
authors.forename: Michael A
authors.initials: MA
authors.lastname: Rubin
mesh_terms: D000368:Aged; D015331:Cohort Studies; D003428:Cross Infection / Q000191:economics*; D003695:Delivery of Health Care / Q000191:economics / Q000706:statistics & numerical data*; D016527:Drug Costs / Q000706:statistics & numerical data; D005260:Female; D017048:Health Care Costs / Q000706:statistics & numerical data*; D006787:Hospitals, Veterans / Q000191:economics / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D055624:Methicillin-Resistant Staphylococcus aureus; D008875:Middle Aged; D013203:Staphylococcal Infections / Q000191:economics*; D014481:United States