Date of Award

2016

Embargo Period

8-1-2024

Document Type

Dissertation

Degree Name

Doctor of Health Administration

College

College of Health Professions

First Advisor

Annie N. Simpson

Second Advisor

Brandi M. White

Third Advisor

Andrew Goodwin

Fourth Advisor

Lisa K. Saladin

Abstract

Objective: To explore the clinical and financial impact of hospital-acquired infections (HAIs) in patients admitted to the Intensive Care Unit (ICU) using statewide representative databases for Washington (WA), New Jersey (NJ), Florida (FL) and New York (NY). Specifically, the following questions will be addressed: 1) Is there an association between HAIs and hospital Length of Stay (LOS) in patients who have an ICU stay ?, 2) Is there an association between HAIs and hospital mortality in patients who have an ICU stay ?, 3) Is there an association between HAIs and hospital cost in patients who have an ICU stay ?, 4) Does the association of HAIs to LOS, mortality and costs vary by type of HAI (as identified by diagnosis related codes) in patients who have ICU stay ?, and 5) Does the association of HAIs to LOS, mortality and cost vary by sex (male or female) in patients who have ICU stay? Methods: Multi-state hospital billing data retrospective cohort study using Healthcare Cost and Utilization Project (HCUP) statewide databases for WA, FL, NJ and NY. Results: HAIs have significant association to clinical and financial indicators within the ICU: LOS increases by a factor of 2.49 times (22.94 days vs. 9.20 days), mortality increases by a factor of 7.149 times, and total adjusted cost increases by a factor of 3.02 times ($68,503 vs. $22,659). Discussion: Certain states such as WA report higher HAI infection rates than others (NY, NJ and FL). It needs to be determined if this is due to higher transparency of reporting and/or under reporting in other states. Some of the larger differences in infection rates could be due to disease severity of patients with HAIs in ICU and non-ICU. Infection control measures need to target HAIs that are more prevalent and costly in the ICU.

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