Correlation between case mix index and antibiotic use in hospitals
Correlation between case mix index and antibiotic use in hospitals
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DOI：
10.1093/jac/dkn275
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发表时间：
2008-10-01
影响因子：
5.2
通讯作者：
Weber, Rainer
中科院分区：
文献类型：
--
作者：
Kuster, Stefan P.;Ruef, Christian;Weber, Rainer
背景：为了比较不同医院或不同医院单位抗生素的使用情况并探讨其差异，对住院患者的病情进行调整是必不可少的。病例组合指数(CMI)是描述单个医院患者平均发病率的经济替代指标(即在规定的时间段内所有住院患者的总费用权重除以入院人数)。方法：采用加权线性回归分析方法，对苏黎世大学三级医院18个科室和瑞士苏黎世州10所一、2所二级急诊医院2006年住院抗菌药物使用情况与医院抗菌药物使用情况进行相关性分析。结果：大学医院不同科室间[限定日剂量/百床日，68.04；20.97~323.37]、一、二级医院间抗菌药物使用差异显著(限定日剂量/百床日，15.45~57.05)。高校医院科室和不同医院的抗菌药物使用与CMI呈正相关，分别以DDD/百床日计算[决定系数(R(2))，0.57(P=0.0002)和0.46(P=0.0065)]和以DDD/百日住院计算[R(2)，0.48(P=0.0008)和0.85(P<；0.0001)]。结论：不同医院和不同急诊医院的抗菌药物使用与CMI相关。对于医院内和医院间抗生素使用的基准，调整CMI可能是一个有用的工具，以考虑到医院类别和患者的发病率的差异。
Background: To compare the quantitative antibiotic use between hospitals or hospital units and to explore differences, adjustment for severity of illness of hospitalized patients is essential. The case mix index (CMI) is an economic surrogate marker (i.e. the total cost weights of all inpatients per a defined time period divided by the number of admissions) to describe the average patients' morbidity of individual hospitals. We aimed to investigate the correlation between CMI and hospital antibiotic use.Methods: We used weighted linear regression analysis to evaluate the correlation between in-hospital antibiotic use in 2006 and CMI of 18 departments of the tertiary care University Hospital Zurich and of 10 primary and 2 secondary acute care hospitals in the Canton of Zurich in Switzerland.Results: Antibiotic use varied substantially between different departments of the university hospital [defined daily doses (DDD)/100 bed-days, 68.04; range, 20.97-323.37] and between primary and secondary care hospitals (range of DDD/100 bed-days, 15.45-57.05). Antibiotic use of university hospital departments and the different hospitals, respectively, correlated with CMI when calculated in DDD/100 bed-days [coefficient of determination (R(2)), 0.57 (P = 0.0002) and 0.46 (P = 0.0065)], as well as when calculated in DDD/100 admissions [R(2), 0.48 (P = 0.0008) and 0.85 (P < 0.0001), respectively].Conclusions: Antibiotic use correlated with CMI across various specialties of a university hospital and across different acute care hospitals. For benchmarking antibiotic use within and across hospitals, adjustment for CMI may be a useful tool in order to take into account the differences in hospital category and patients' morbidities.