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VA中MRSA非殖民化对退伍军人医疗保健的预期影响通过检查设施级非殖民化使用与MRSA感染率之间的关联，以及MRSA感染对住院时间和出院后费用的影响，我们将提供有价值的见解，以了解是否将去殖民化添加到旨在控制耐甲氧西林金黄色葡萄球菌（MRSA）的VA范围倡议中的具体问题医院内感染。通过这项研究和培训经验，我将准备在其他医疗保健获得性和社区获得性感染中进行类似的研究，这些感染可能会影响整个VA医疗保健系统的感染控制实践。 传染病治疗的独特之处在于，它们会产生外部性，即目前未感染的个人会感受到的溢出效应。虽然这些外部因素得到了承认，但其规模却没有得到很好的衡量。同样，医院感染对医疗保健成本和利用的影响也没有准确量化。这两个要素（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应用先进的经验方法来估计传染病传播的预防工作的成本和效益的具体情况下，非殖民化的MRSA在VA。本研究有三个目的：（1）量化与MRSA阳性退伍军人的去殖民化相关的正外部性，（2）估计VA中与医院获得性MRSA感染相关的成本和医疗保健使用，以及（3）对MRSA策略进行经济分析，该策略将去殖民化添加到VA当前的VA接触隔离策略中。 方法在目标（1）中，我们将 使用从患者护理服务（PCS）获得的VA患者数据的全国性数据库，使用多水平逻辑回归估计医院级去殖民化使用和对该去殖民化的抵抗与医院获得性MRSA感染风险之间的关联。接下来，我们将把PCS数据与VA决策支持系统（DSS）数据联系起来，使用纵向logistic回归中的逆概率权重估计MRSA感染对住院时间的影响，并使用适用于偏斜数据的广义线性模型估计MRSA感染对出院后医疗保健成本和利用的影响，见Aim（2）。 此外，我们将把PCS和DSS数据与Medicare和VA Fee Basis数据联系起来，以获取VA以外的出院后医疗保健费用。最后，在目标（3）中，我们将使用结果 目的（1）和（2）作为输入到基于代理的MRSA传播模型进行动态经济分析。

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.