1206 infection control & hospital epidemiology october 2017, vol. 38, no. 10


table 1. Characteristics of Patients in the Two Study Periods Characteristic


Mean age, years Sex, female


Mean body mass index


Race/Ethnicity White Black Other


Median length of stay (IQR), days Median DRG weight, (IQR)


Hospital admissions HUP


PPMC PAH


Admission type Elective


Emergency Department Transfer


Discharging Service Medicine Surgery Mixed


Women’s health Critical care


Top 5 major diagnostic categories 1–Circulatory system


2–Pregnancy, childbirth and puerperium 3–Musculoskeletal system and connective tissue 4–Digestive system 5–Nervous system


(N=69,362), No. (%)a 54.3


Preintervention


39,606 (57.1) 29.0


34,982 (50.4) 26,684 (38.5) 7,696 (11.1) 3 (2–6)


1.18 (0.81–1.93)


35,452 (51.1) 14,667 (21.1) 19,243 (27.7)


19,828 (28.6) 27,504 (39.7) 21,977 (31.7)


16,429 (26.5) 18,729 (30.2) 14,033 (22.7) 10,089 (16.3) 2,659 (4.3)


10,972 (29.6) 9,048 (24.4) 7,239 (19.5) 5,563 (15.0) 4,269 (11.5)


PPMC, Penn Presbyterian Medical Center; PAH, Pennsylvania Hospital. aUnless otherwise specified.


Statistical Methods


Data were analyzed using χ2 and t-test statistics to compare dichotomous and continuous outcomes, respectively, before and after the CCDS intervention was implemented. Table 1 was generated using χ2 analysis for categorical data and Mann-Whitney U for continuous variables. All analyses were performedwith the use of Stata 12.1 software (Stata Corp, College Station, Texas, USA). The study received expedited approval and a Health Insurance Portability and Accountability Act waiver from our institutional review board.


results


In total, 69,362 hospital admissions occurred and 4,498 C. difficile tests were ordered in the preintervention period and 67,814 hospital admissions occurred and 4,396 tests were ordered in the postintervention period. Compared to the preintervention period, small but statistically significant differences were observed in the distributions of admissions between hospitals, discharging service, and major diagnostic


categories. The median length of stay was longer during the intervention period (Table 1). The C. difficile CCDS tool was associated with a decrease


in the proportion of inappropriate C. difficile testing sent (preintervention vs postintervention: 29.6% vs 27.3%; P=.02) (Figure 1). In 2 of the hospitals, HUPand PAH, the proportion of inappropriate testing decreased (32.5% vs 29.9%; P=.03; 26.1% vs 22.6%; P=.11), while in PPMC, a nonsignificant increase was observed (21.1% vs 21.7%; P=.8). We observed increases in the proportion of instances inwhich


patients had their laxatives discontinued at the time of an intended C. difficile order with no testing sent during that order (preintervention vs postintervention: 5.8% vs 46.4%; P<.01) and where patients had their laxatives discontinued with C. difficile testing sent during that order (5.4% vs 35.2%; P<.01) (Table 2). There were no significant changes in the overall proportion of patients with C. difficile testing (6.5% vs 6.5%; P=.99), positive C. difficile tests (14.0% of tests vs 13.7%; P=.67), and false-positive C. difficile tests (27.6% of positive C. difficile tests vs 26.2%; P=.62).Inaddition,for thosewith hospital-acquired C. difficile, we observed a nonsignificant


(N=67,814), No. (%)a 54.5


Postintervention


P Value .071


38,858 (57.3) 29.1


34,014 (50.2) 26,157 (38.6) 7,643 (11.3) 4 (2–7)


1.17 (0.82–2.04)


33,898 (50.0) 15,015 (22.1) 18,901 (27.9)


18,930 (27.9) 26,976 (39.8) 21,888 (32.3)


15,868 (26.6) 17,855 (30.0) 13,242 (22.2) 10,140 (17.0) 2,484 (4.2)


10,426 (28.4) 9,357 (25.5) 7,169 (19.5) 5,455 (14.8) 4,336 (11.8)


.556 .051


.214


<.001 <.001


<.001 <.001 <.001


<.001


NOTE: IQR, interquartile range; DRG; diagnosis-related group; HUP, Hospital of the University of Pennsylvania;


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