title: Impact of Evidence-Based Guidelines on Outcomes of Hospitalized Patients With Clostridium difficile Infection.
abstract: OBJECTIVE
  Clostridium difficile infection (CDI) is the most common healthcare-associated infection in the United States. Clinical practice guidelines for the treatment of CDI were updated in 2010 by the Society for Healthcare Epidemiology of America and the Infectious Diseases Society of America. An institutional guideline for the classification and management of CDI in accordance with the 2010 Society for Healthcare Epidemiology of America/Infectious Diseases Society of America guideline was developed and provided to attending physicians and medical residents in multiple formats.
  
  
  METHODS
  We sought to determine the impact of an evidence-based guideline for the treatment of CDI at a community teaching hospital. A retrospective chart review was conducted to identify length of stay (LOS), readmission rates, direct cost, mortality, and physician adherence to guidelines in patients with International Classification of Diseases, Ninth Edition codes and laboratory confirmation of CDI between February 1, 2013 and January 31, 2014. Endpoints included LOS after diagnosis of CDI, 30-day readmission rates, direct cost after diagnosis of CDI, and mortality.
  
  
  RESULTS
  A total of 351 patient encounters were included in the study. Although not statistically significant, it was found that guideline-based therapy (n = 131) was associated with a lower median LOS (6 days vs 8 days; P = 0.06). Thirty-day hospital readmission (25.2% vs 29.5%; P = 0.39) and median cost after diagnosis of CDI ($7238.48 vs $8794.81; P = 0.10) also were lower but not statistically significant. Patients with mild-to-moderate infection were found to have a significantly lower median LOS (5 days vs 7 days; P = 0.03) and median cost after diagnosis ($5257.85 vs $7680.56; P = 0.03) when treated with guideline-based therapy. Overall physician adherence to guidelines was low, at 38%.
  
  
  CONCLUSIONS
  Treatment with guideline-based therapy for CDI was associated with a trend toward a significantly lower LOS and cost. Barriers to physician adherence to guidelines still exist, despite education and guideline availability. Electronic health record-based order sets or clinical decision tools may improve recognition of and adherence to guidelines.
authors.affiliation: From St Vincent Hospital & Health Services, Indianapolis, Indiana, and Butler University College of Pharmacy and Health Sciences, Indianapolis, Indiana.
authors.forename: Stephen J
authors.initials: SJ
authors.lastname: Knaus
authors.affiliation: From St Vincent Hospital & Health Services, Indianapolis, Indiana, and Butler University College of Pharmacy and Health Sciences, Indianapolis, Indiana.
authors.forename: Lindsay
authors.initials: L
authors.lastname: Saum
authors.affiliation: From St Vincent Hospital & Health Services, Indianapolis, Indiana, and Butler University College of Pharmacy and Health Sciences, Indianapolis, Indiana.
authors.forename: Emily
authors.initials: E
authors.lastname: Cochard
authors.affiliation: From St Vincent Hospital & Health Services, Indianapolis, Indiana, and Butler University College of Pharmacy and Health Sciences, Indianapolis, Indiana.
authors.forename: Wesley
authors.initials: W
authors.lastname: Prichard
authors.affiliation: From St Vincent Hospital & Health Services, Indianapolis, Indiana, and Butler University College of Pharmacy and Health Sciences, Indianapolis, Indiana.
authors.forename: Brian
authors.initials: B
authors.lastname: Skinner
authors.affiliation: From St Vincent Hospital & Health Services, Indianapolis, Indiana, and Butler University College of Pharmacy and Health Sciences, Indianapolis, Indiana.
authors.forename: Ryan
authors.initials: R
authors.lastname: Medas
mesh_terms: D000368:Aged; D016360:Clostridioides difficile; D004761:Enterocolitis, Pseudomembranous / Q000191:economics / Q000401:mortality / Q000628:therapy*; D019317:Evidence-Based Medicine; D005260:Female; D019983:Guideline Adherence; D006784:Hospitals, Teaching; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D010359:Patient Readmission; D017410:Practice Guidelines as Topic; D012189:Retrospective Studies; D016896:Treatment Outcome