Cephalexin is associated with Lower Hospital Readmission Rates for Kidney and Urinary Tract Infections Patients at Christiana Care Wilmington Hospital based on Real World Evidence Study of Medicare Claims Data


In Cephalexin, Kidney and Urinary Tract Infections

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By: Sara Riascos  Apr. 14, 2022

Background:

Kidney and Urinary Tract Infections are frequently associated with hospital readmission. Readmission is a hospital quality measure that reflects dimensions of quality of inpatient care and also impacts overall programs by payors such as CMS’s Star Rating Program, HRRP and Value-Based Purchasing. Cephalexin is an antibiotic used to treat infections caused by susceptible bacteria. Studies have shown that cephalexin for treatment of outpatient UTI resulted in fewer treatment failures than TMP-SMX or amoxicillin.

Dexur’s analysis of Real World Evidence based on Medicare Claims data showed that the use of Cephalexin within 7 days of hospitalization was associated with lower hospital readmission rates for Kidney and Urinary Tract Infections Patients at Christiana Care Wilmington Hospital in Wilmington, Delaware. Reduction in readmission rates helps hospitals improve their outcomes for various cost and quality programs. Dexur is an approved entity to perform Medicare claims data analysis, which it uses to perform quality outcomes analysis. Dexur has published several papers with Harvard Medical School on quality outcomes related topics. Dexur’s analysis of Drugs and their impact on quality outcomes, such as readmissions and mortality, are used by Hospitals, IDNs, and ACOs to implement best practices and manage Real World Evidence based risk factors.

Methods:

We conducted a retrospective study using Dexur’s analysis of Real World Evidence from Medicare Claims data, for hospitalizations at Christiana Care Wilmington Hospitalbetween January 2017 to September 2019. Our methodology criteria was as follows:

  1. Inclusion Criteria: Selected Medical Hospitalizations with Primary Diagnosis with Kidney and Urinary Tract Infections related codes (Listed in table below)
  2. Stratified Selected population into cohorts
    1. Kidney and Urinary Tract Infections patients who dispensed Cephalexin within 7 Days of Hospitalization using Part D drugs claims database
    2. Kidney and Urinary Tract Infections patients who did not dispense Cephalexin within 7 Days of Hospitalization
  3. 30 Day readmission rates were analyzed for both population cohorts

Results:

Overall, Cephalexin was associated with lower hospital readmission rates for all Primary DRG Diagnosis Codes examined at Christiana Care Wilmington Hospital. For patients whose primary DRG Diagnosis was “Kidney and Urinary Tract Infections, unspecified organism”(A419) and when Cephalexin was used within 7 days of hospitalization, the readmission rate was 9.65% compared to the cohort where Cephalexin was not used, whose readmission rate was 17.27%. The readmission odds ratio for these cohorts was 0.51. The use of Cephalexin was associated with a 49% lower readmission rate when used within 7 days of hospitalization. The full list of studied DRG codes, readmission rates, odds ratios, confidence intervals, and percentage reduction in readmission with Cephalexin at Christiana Care Wilmington Hospitalis shown below.


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Primary DRG Diagnosis Code Primary DRG Diagnosis Code Description Total Hospitalizations without Cephalexin Readmission Without Cephalexin Readmission Rate without Cephalexin Total Hospitalizations with Cephalexin Readmission with Cephalexin Readmission Rate with Cephalexin Readmission Odds Ratio Reduction in Readmission with Cephalexin (%) Confidence Interval (-) Confidence Intervals (+)
690 Kidney And Urinary Tract Infections Without Major Complication Or Comorbidity (MCC) 1,419

Dexur also leveraged Medicare claims data to understand what percentage of patients hospitalized with Kidney and Urinary Tract Infections were not prescribed Cephalexin within 7 days of discharge.

DRG CODE Hospital Hospitalizations with Kidney and Urinary Tract Infections % of Hospitalizations without Cephalexin
690 Christiana Care Wilmington Hospital 1,430 99.23%
Evanston Hospital 715 At Least 98.6%
Florida Hospital Orlando 1,355 At least 99.26%

​Hospitalizations with Kidney and Urinary Tract Infections = Above Listed DRG Codes

If figures are shared with “At Least” - this implies that the drug utilization within 7 days post hospitalization is less than 11

Conclusions:

According to analysis of Real World Evidence of Medicare Claims data, for hospitalizations between January January 2017 to September 2019, the use of Cephalexin within 7 days of hospitalization can lead to substantial reductions in hospital readmission rates of Kidney and Urinary Tract Infections patients at Christiana Care Wilmington Hospital. This analysis shows that a significant number of Patients are not dispensed Cephalexin after Kidney and Urinary Tract Infections hospitalizations at Christiana Care Wilmington Hospitalor major US Hospitals.