Inman K J, Dymock K, Fysh N, Robbins B, Rutledge F S, Sibbald W J
London Health Sciences Centre, Ontario, Canada.
Adv Wound Care. 1999 Mar;12(2):72-80.
To compare the clinical utility, in terms of incidence of pressure ulcer (PU) development, and economic impact of 2 programs of patient surface assignment for PU prevention.
Randomized controlled clinical trial with economic evaluation.
30-bed multidisciplinary intensive care unit (ICU), serving as the regional trauma center.
144 consecutive eligible patients at risk for the development of PUs.
PU risk was assessed on admission using the Skin Ulcer Risk Evaluation (SURE) Score, and patients were randomized to either the experimental (purchase) or control group (purchase/rent). Based on their SURE Score, patients were assigned a specialty surface if needed. Patients received head-to-toe skin assessments twice weekly, new PUs were documented, a new SURE Score was calculated, and specialty surfaces were upgraded or downgraded as necessary.
The incidence of PUs by site and severity, and cost.
Multivariate logistic regression and decision modeling.
No significant differences were detected between groups with respect to baseline population characteristics, nor in the development of PUs. Predictors of PU development were ICU length of stay and SURE Score. The experimental (purchase) group was the less costly strategy. Under baseline assumptions, surface costs per at-risk patient were $76 CDN and $171 CDN in the experimental and control groups, respectively. The savings of $95 CDN per at-risk patient translates into conservative annual savings of $47,500 CDN.
Using an objective, risk-based method of patient surface assignment, the authors compared the clinical and economic outcomes of 2 programs of PU prevention. In a direct comparison of alternatives, the strategy that emphasized purchased rather than rented products proved to be the more economical. Finally, this approach illustrates how by prospectively capturing data on both the costs and consequences of competing alternatives, a more objective and informed decision-making process can result.
就压疮（PU）发生情况及两种预防PU的患者体位分配方案的经济影响，比较二者的临床效用。
带有经济评估的随机对照临床试验。
拥有30张床位的多学科重症监护病房（ICU），为地区创伤中心。
144例连续入选的有发生PU风险的合格患者。
入院时使用皮肤溃疡风险评估（SURE）评分评估PU风险，患者被随机分为试验组（购买）或对照组（购买/租赁）。根据SURE评分，必要时为患者分配特殊体位。患者每周接受两次从头到脚的皮肤评估，记录新发生的PU，计算新的SURE评分，并根据需要升级或降级特殊体位。
按部位和严重程度划分的PU发生率及成本。
多变量逻辑回归和决策建模。
两组在基线人群特征方面以及PU发生情况上均未检测到显著差异。PU发生的预测因素为ICU住院时间和SURE评分。试验组（购买）是成本较低的策略。在基线假设下，试验组和对照组中每位有风险患者的体位成本分别为76加元及171加元。每位有风险患者节省95加元，保守估计每年可节省47,500加元。
作者使用一种基于风险的客观患者体位分配方法，比较了两种PU预防方案的临床和经济结果。在对替代方案的直接比较中，强调购买而非租赁产品的策略被证明更经济。最后，这种方法说明了通过前瞻性收集竞争替代方案的成本和结果数据，如何能产生更客观、明智的决策过程。
