1 Cornell Institute for Healthy Futures, Department of Design and Environmental Analysis, Cornell University, Ithaca, NY, USA.
2 Department of Geriatrics, Weill Cornell Medical College, New York, NY, USA.
J Intensive Care Med. 2019 Feb;34(2):115-125. doi: 10.1177/0885066616689774. Epub 2017 Jan 25.
: There is increasing evidence that the physical environment of neonatal intensive care units (NICUs), including single-family rooms (SFRs) versus open-bay rooms (OPBYs), has tangible effects on vulnerable patients. The objective of this study was to illustrate the financial implications of SFR versus OPBY units by synthesizing and evaluating the evidence regarding the benefits and costs of each unit from a hospital perspective.
: We assumed a hypothetical NICU with 40 beds in OPBY rooms, to be replaced with a new NICU with 32 SFRs and 8 OPBYs. We synthesized evidence regarding the comparative benefit of each option on 3 outcomes-nosocomial infections, length of stay, and direct costs. We calculated incremental benefit-cost ratio separately considering each outcome over an analysis period of 5 years. A ratio of more than 1 indicates that the investment is worthwhile. Input parameters were assigned probability distributions representing the degree of uncertainty around their true values. Monte Carlo simulation with 5000 iterations was used to quantify the distribution of benefits and costs.
: The mean value of the incremental benefit-cost ratio was 0.730 (95% credible interval: 0.724-0.735) when nosocomial infections were considered, 1.298 (1.282-1.315) when reduced length of stay was considered, and 1.794 (1.783-1.804) when direct costs of care were compared. The probability of a benefit-cost ratio of lower than 1 was about 91%, 31%, and 2% in each case, respectively.
: Cost savings associated with SFR units would justify additional construction and operation costs compared to OPBY units only when evidence on inclusive outcomes such as length of stay or direct costs of care is considered. A specific outcome such as infection rate potentially fails to capture all benefits of SFRs. As more evidence becomes available on full benefits and hazards of SFRs versus OPBYs, future studies should investigate the broader return-on-investment outcomes.
越来越多的证据表明，新生儿重症监护病房（NICU）的物理环境，包括单人间（SFR）与开放式婴儿床区（OPBY），对脆弱的患者有切实的影响。本研究的目的是从医院的角度综合和评估每种病房单元的效益和成本方面的证据，说明 SFR 与 OPBY 病房单元的财务影响。
我们假设一个拥有 40 张 OPBY 床的 NICU，将其替换为一个拥有 32 个 SFR 和 8 个 OPBY 的新 NICU。我们综合了关于每个病房单元在 3 个结果（医院感染、住院时间和直接成本）上比较效益的证据。我们分别考虑每个结果，在 5 年的分析期间内计算增量效益成本比。比值大于 1 表示投资是值得的。输入参数被分配概率分布，代表其真实值的不确定性程度。使用 5000 次迭代的蒙特卡罗模拟来量化效益和成本的分布。
当考虑医院感染时，增量效益成本比的平均值为 0.730（95%可信区间：0.724-0.735），当考虑缩短住院时间时，为 1.298（1.282-1.315），当比较护理的直接成本时，为 1.794（1.783-1.804）。在每种情况下，效益成本比低于 1 的概率分别约为 91%、31%和 2%。
只有当考虑包括住院时间或护理直接成本等在内的综合结果的证据时，SFR 病房单元与 OPBY 病房单元相比节省的成本才足以证明其额外的建设和运营成本是合理的。特定的结果（如感染率）可能无法捕获 SFR 的所有效益。随着关于 SFR 与 OPBY 的全面效益和风险的更多证据出现，未来的研究应该调查更广泛的投资回报结果。
