Camamo James M, Weibel Kurt, O'Keeffe Terence, Huckleberry Yvonne, Kopp Brian J, Diven Conrad, Erstad Brian L
University of Arizona Medical Center, Department of Pharmacy Services, Tucson, AZ; The University of Arizona College of Pharmacy, Department of Pharmacy Practice and Science, Tucson, AZ.
University of Arizona Medical Center, Department of Pharmacy Services, Tucson, AZ; The University of Arizona College of Pharmacy, Department of Pharmacy Practice and Science, Tucson, AZ.
J Crit Care. 2014 Oct;29(5):814-6. doi: 10.1016/j.jcrc.2014.05.016. Epub 2014 May 29.
The purpose of this evaluation is to describe the cost savings associated with multimodal interventions aimed at reducing aerosolized bronchodilator use in mechanically ventilated patients without adversely affecting costs associated with length of stay (LOS).
Subjects were included in the analysis if they were aged more than 18 years, on mechanical ventilation in the intensive care unit, and received aerosolized bronchodilators. Patients were excluded if they had reversible airway disease, an indication needing bronchodilator therapy. Patient data were obtained using the University Health System Consortium Clinical Data Base/Resource Manager (Chicago, IL) to compare outcomes during two 6-month periods separated by a 4-month intervention phase aimed to reduce bronchodilator use.
There were no significant differences in age, sex, and LOS (observed and expected) between the preintervention and postintervention phases. Based on whole acquisition costs, the total cost of bronchodilators dispensed to the adult intensive care units over the 6-month postintervention phase was reduced by $56960 compared with the 6-month preintervention phase ($120562 vs $63602, respectively).
Multimodal efforts to restrict aerosolized bronchodilator therapy in mechanically ventilated patients were successful and led to sustained reductions in use that was associated with substantial reductions in cost, without affecting LOS.
本评估旨在描述多模式干预措施所带来的成本节约情况，这些干预措施旨在减少机械通气患者雾化支气管扩张剂的使用，同时不会对住院时间（LOS）相关成本产生不利影响。
纳入分析的受试者需年龄超过18岁，在重症监护病房接受机械通气，并接受雾化支气管扩张剂治疗。若患者患有可逆性气道疾病或有支气管扩张剂治疗指征，则被排除。使用大学卫生系统联盟临床数据库/资源管理器（伊利诺伊州芝加哥）获取患者数据，以比较两个6个月期间的结果，这两个期间由一个旨在减少支气管扩张剂使用的4个月干预阶段隔开。
干预前和干预后阶段在年龄、性别和住院时间（观察到的和预期的）方面没有显著差异。基于全部购置成本，与干预前6个月阶段相比，干预后6个月阶段分配给成人重症监护病房的支气管扩张剂总成本降低了56960美元（分别为120562美元和63602美元）。
在机械通气患者中限制雾化支气管扩张剂治疗的多模式努力取得了成功，导致其使用持续减少，这与成本大幅降低相关，且未影响住院时间。
