Department of Emergency Medicine and Division of Education, Lehigh Valley Health Network, Allentown, Pennsylvania 18103, USA.
J Patient Saf. 2011 Jun;7(2):85-91. doi: 10.1097/PTS.0b013e31821b3ab6.
The Center for Medicare and Medicaid Services recently declared that central venous catheter-associated bloodstream infections (CLABs) are preventable and no longer reimbursable. The new penalty paradigm creates substantial economic incentives for hospitals to eliminate infections. Modeling exercises offer the opportunity to justify expenditures for the prevention of rare patient safety events.
We constructed a decision analytic model of the theoretical impact of an educational intervention to improve the safety of central venous catheter insertion. This methodology allows for decision nodes representing procedure urgency, procedure locations, and effects of education on both infectious and mechanical complications. We performed deterministic sensitivity analyses to estimate effects of changes in complication rates, educational impact, and cost.
In an already safety system (CLAB rate of 1:1000 line days or 0.7%), the initial sensitivity results suggest that if education results in a 50% reduction in CLAB and a 25% reduction in mechanical complications, survival is equal, and cost is increased by $92,400 in a large hospital system annually. If all CLAB and mechanical complications are eliminated, survival improves slightly, and cost is reduced by $64,800 annually.
These results suggest that if the educational intervention is effective, a small increase in cost can reduce complications. Our analysis does not consider increased revenue generated by virtual bed capacity increases or dynamic changes in practice. This model serves as a template for other health care institutions to estimate the costs and benefits of their own proposed educational interventions.
医疗保险和医疗补助服务中心最近宣布，中心静脉导管相关血流感染（CLAB）是可预防的，不再予以报销。新的惩罚模式为医院消除感染创造了巨大的经济激励。建模练习为证明预防罕见患者安全事件的支出提供了机会。
我们构建了一个决策分析模型，用于理论上评估教育干预措施对提高中心静脉导管插入安全的影响。这种方法允许决策节点代表程序紧急情况、程序位置以及教育对感染和机械并发症的影响。我们进行了确定性敏感性分析，以估计并发症发生率、教育效果和成本的变化。
在现有的安全系统（CLAB 发生率为 1:1000 导管日或 0.7%）中，初始敏感性结果表明，如果教育导致 CLAB 减少 50%，机械并发症减少 25%，则在大型医院系统中，每年的生存状况是相同的，成本增加了 92400 美元。如果所有的 CLAB 和机械并发症都得到消除，生存状况略有改善，每年的成本减少 64800 美元。
这些结果表明，如果教育干预措施有效，成本的小幅度增加可以减少并发症。我们的分析没有考虑到虚拟床位容量增加或实践动态变化带来的额外收入。该模型可作为其他医疗机构评估其自身拟议教育干预措施的成本和收益的模板。
