Xakellis G C, Frantz R A, Lewis A, Harvey P
University of California at Davis, Department of Family and Community Medicine, Sacramento, USA.
Adv Skin Wound Care. 2001 Sep-Oct;14(5):249-56, 258. doi: 10.1097/00129334-200109000-00012.
To determine the cost-effectiveness of a guideline-based pressure ulcer prevention protocol over time.
Retrospective and prospective quasi-experimental longitudinal design. Costs are presented from the long-term-care facility perspective. Data collection occurred for 3 periods: the first 6 months of 1994 (prior to protocol implementation), the first 6 months of 1995 (immediately following implementation) and the first 6 months of 1997 (2 years following implementation).
77-bed long-term-care facility
PATIENTS/PARTICIPANTS: Subjects were ulcer-free facility residents at the start of each data collection period. There were 69 subjects in the 1994 sample, 63 in the 1995 sample, and 71 in the 1997 sample.
A guideline-based pressure ulcer prevention protocol was implemented during the last 3 months of 1994. The protocol consisted of specific policies for pressure ulcer prevention and treatment, intensive staff education on pressure ulcer care, and monitoring with regular performance feedback to staff.
Time to ulcer development varied among the 3 groups (log rank = 8.81, P = .01), with longer time to ulcer development in 1995 compared with 1994; no difference was seen between 1997 and 1994. The time for ulcers to heal decreased over the 3 years (log rank = 9.49, P <.01), with ulcer healing time being shorter in 1995 and 1997 compared with 1994. Total costs were unchanged during the 3 years (F = 0.2, P =.81). Costs of treatment declined significantly from 1994 to 1995 and 1997 (F = 5.5, P <.01) and costs of prevention increased significantly from 1994 to 1995 and 1997(F = 15, P <.01). From 1994 to 1997, the cost for 1 day of ulcer-free life was $3.50.
Implementation of a pressure ulcer prevention protocol showed mixed results. Initial reductions in pressure ulcer incidence were lost over time. Clinical results of ulcer treatment, however, improved and treatment costs fell during the 3 years. Implementation of preventive programs poses a major leadership challenge.
确定基于指南的压疮预防方案随时间推移的成本效益。
回顾性和前瞻性准实验纵向设计。成本从长期护理机构的角度呈现。数据收集分3个阶段进行：1994年的前6个月（方案实施前）、1995年的前6个月（实施后立即进行）和1997年的前6个月（实施后2年）。
拥有77张床位的长期护理机构
患者/参与者：在每个数据收集阶段开始时，受试者为该机构中无溃疡的居民。1994年样本中有69名受试者，1995年样本中有63名，1997年样本中有71名。
1994年最后3个月实施了基于指南的压疮预防方案。该方案包括压疮预防和治疗的具体政策、针对压疮护理的强化员工教育以及对员工进行定期绩效反馈的监测。
3组之间溃疡发生时间不同（对数秩检验=8.81，P = 0.01），1995年溃疡发生时间比1994年长；1997年与1994年之间无差异。3年中溃疡愈合时间缩短（对数秩检验=9.49，P <0.01），1995年和1997年溃疡愈合时间比1994年短。3年期间总成本未变（F = 0.2，P = 0.81）。治疗成本从1994年到1995年和1997年显著下降（F = 5.5，P <0.01），预防成本从1994年到1995年和1997年显著增加（F = 15，P <0.01）。从1994年到1997年，无溃疡一天的成本为3.50美元。
压疮预防方案的实施结果喜忧参半。随着时间的推移，压疮发病率最初的降低情况消失了。然而，溃疡治疗的临床结果有所改善，且3年期间治疗成本下降。预防性方案的实施对领导力构成了重大挑战。
