Value of hospital resources for effective pressure injury prevention: a cost-effectiveness analysis.
| Autor: | Padula, William V., Pronovost, Peter J., Makic, Mary Beth F., Wald, Heidi l., Moran, Dane, Mishra, Manish K., Meltzer, David O. |
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| Předmět: |
BEDSORE risk factors
COST effectiveness PRESSURE ulcers HEALTH facilities MACHINE learning MATHEMATICAL models NURSING assessment RESEARCH RESEARCH funding RISK assessment STATISTICS DATA warehousing THEORY SEVERITY of illness index QUALITY-adjusted life years ELECTRONIC health records DESCRIPTIVE statistics PREVENTION ULCERS DISEASE risk factors |
| Zdroj: | BMJ Quality & Safety; Feb2019, Vol. 28 Issue 2, p132-141, 10p, 1 Diagram, 3 Charts, 1 Graph |
| Abstrakt: | Objective Hospital-acquired pressure injuries are localised skin injuries that cause significant mortality and are costly. Nursing best practices prevent pressure injuries, including time-consuming, complex tasks that lack payment incentives. The Braden Scale is an evidence-based stratification tool nurses use daily to assess pressure-injury risk. Our objective was to analyse the cost-utility of performing repeated risk-assessment for pressure-injury prevention in all patients or high-risk groups. Design Cost-utility analysis using Markov modelling from US societal and healthcare sector perspectives within a 1-year time horizon. Setting Patient-level longitudinal data on 34 787 encounters from an academic hospital electronic health record (EHR) between 2011 and 2014, including daily Braden scores. Supervised machine learning simulated age-adjusted transition probabilities between risk levels and pressure injuries. Participants Hospitalised adults with Braden scores classified into five risk levels: very high risk (6-9), high risk (10-11), moderate risk (12-14), at-risk (15-18), minimal risk (19-23). Interventions Standard care, repeated risk assessment in all risk levels or only repeated risk assessment in highrisk strata based on machine-learning simulations. Main outcome measures Costs (2016 $US) of pressure-injury treatment and prevention, and qualityadjusted life years (QALYs) related to pressure injuries were weighted by transition probabilities to calculate the incremental cost-effectiveness ratio (ICER) at $100 000/ QALY willingness-to-pay. Univariate and probabilistic sensitivity analyses tested model uncertainty. Results Simulating prevention for all patients yielded greater QALYs at higher cost from societal and healthcare sector perspectives, equating to ICERs of $2000/QALY and $2142/QALY, respectively. Risk-stratified follow-up in patients with Braden scores <15 dominated standard care. Prevention for all patients was cost-effective in >99% of probabilistic simulations. Conclusion Our analysis using EHR data maintains that pressure-injury prevention for all inpatients is costeffective. Hospitals should invest in nursing compliance with international prevention guidelines. [ABSTRACT FROM AUTHOR] |
| Databáze: | Complementary Index |
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