Using Economics and Epidemiology to Evaluate MRSA Decolonization in the VA

描述(由申请人提供)： 使用经济学和流行病学评估退伍军人事务部非殖民化对退伍军人医疗保健的预期影响通过研究设施水平非殖民化使用率与MRSA感染率之间的关系，以及MRSA感染对住院时间和出院后成本的影响，我们将提供有价值的见解，以确定是否将非殖民化添加到退伍军人医院内旨在控制耐甲氧西林金黄色葡萄球菌(MRSA)感染的退伍军人医院倡议中。通过这次研究和培训经验，我将准备在其他可能影响退伍军人管理局医疗系统感染控制实践的医疗保健获得性和社区获得性感染中进行类似的研究。项目背景传染病的治疗方法是独特的，因为它们产生外部性，即目前未感染的个人可以感受到的溢出效应。尽管人们认识到了这些外部性，但它们的规模并没有得到很好的衡量。同样，医院感染对卫生保健成本和利用的影响也没有得到准确的量化。这两个因素(外部性和成本)是对任何传染病治疗战略进行经济分析的重要投入。项目目标本研究的目标是将估计传染病传播预防工作的成本和收益的尖端经验方法应用于退伍军人事务部内MRSA非殖民化的具体案例。这项研究有3个目标：(1)量化与MRSA阳性退伍军人非殖民化相关的积极外部性；(2)估计与退伍军人管理局医院获得的MRSA感染相关的成本和医疗用途；(3)对MRSA战略进行经济分析，该战略将非殖民化添加到退伍军人管理局当前的接触隔离战略中。方法在目标(1)中，我们将 使用从患者护理服务(PCS)获得的VA患者数据的全国数据库，使用多水平Logistic回归估计医院层面非殖民化使用和对这种非殖民化的抵制与医院获得的MRSA感染风险之间的关联。接下来，我们将把这些PCS数据与退伍军人管理局决策支持系统(DSS)的数据联系起来，在AIM(2)中，使用纵向Logistic回归中的逆概率权重来估计MRSA感染对住院时间的影响，以及使用适用于不对称数据的广义线性模型来估计出院后医疗保健成本和利用率的影响。此外，我们将把这些PCS和DSS数据与联邦医疗保险和退伍军人管理局的费用基础数据联系起来，以获取退伍军人管理局以外的出院后医疗保健成本。最后，在目标(3)中，我们将使用结果 将AIMS(1)和(2)作为基于主体的耐甲氧西林金黄色葡萄球菌传播模型的输入，进行动态经济分析。

DESCRIPTION (provided by applicant): Using Economics and Epidemiology to Evaluate MRSA Decolonization in the VA Anticipated Impact on Veteran's Health Care By examining the associations between facility-level decolonization usage and MRSA infection rates, as well as the impact of MRSA infections on length of inpatient stay and post-discharge costs, we will provide valuable insight into the specific question of whether to add decolonization to the VA-wide initiative aimed at controlling Methicillin-resistant Staphylococcus aureus (MRSA) infections within VA hospitals. Through this research and training experience, I will be prepared to conduct similar research in other healthcare-acquired and community-acquired infections that could impact infection control practice throughout the VA healthcare system. Project Background Treatments for infectious diseases are unique in that they produce externalities, spillover effects that are felt by individuals who are currently not infected. While these externalities are recognized, their magnitude is not well measured. Similarly, the impact of nosocomial infections on health care cost and utilization has not been quantified accurately. These two elements (externalities and costs) are important inputs to an economic analysis of any infectious disease treatment strategy. Project Objectives The goal of this research is to apply cutting edge empirical methods of estimating the costs and benefits of prevention efforts for infectious disease transmission to the specific case of decolonization of MRSA within the VA. This research has 3 aims: (1) quantify the positive externalities associated with decolonization of MRSA positive veterans, (2) estimate the cost and healthcare use associated with hospital-acquired MRSA infections in the VA, and (3) perform economic analyses of a MRSA strategy that adds decolonization to the VA's current VA strategy of contact isolation. Methods In Aim (1), we will use a nationwide database of VA patient data obtained from Patient Care Services (PCS) to estimate the association between hospital-level decolonization use and resistance to this decolonization and the risk of hospital-acquired MRSA infection using multi- level logistic regressions. Next we will link this PCS data to VA Decision Support System (DSS) data to estimate the impact of MRSA infection on inpatient length of stay using inverse probability weights in a longitudinal logistic regression and on post-discharge health care costs and utilization using generalized linear models that are appropriate for skewed data, in Aim (2). In addition, we will link this PCS and DSS data to Medicare and VA Fee Basis data to capture post-discharge health care costs from outside the VA. Finally, in Aim (3), we will use the results for Aims (1) and (2) as inputs to an agent-based model of MRSA transmission to conduct dynamic economic analyses.