一项针对四家大型成人三级护理医院的回顾性观察研究：全卫生系统患者血液管理计划带来的改善结果与成本降低

Improved outcomes and reduced costs associated with a health-system-wide patient blood management program: a retrospective observational study in four major adult tertiary-care hospitals.

作者信息

Leahy Michael F, Hofmann Axel, Towler Simon, Trentino Kevin M, Burrows Sally A, Swain Stuart G, Hamdorf Jeffrey, Gallagher Trudi, Koay Audrey, Geelhoed Gary C, Farmer Shannon L

机构信息

School of Medicine and Pharmacology, The University of Western Australia.

Department of Haematology, Royal Perth Hospital.

出版信息

Transfusion. 2017 Jun;57(6):1347-1358. doi: 10.1111/trf.14006. Epub 2017 Feb 2.

DOI:10.1111/trf.14006

PMID:28150313

Abstract

BACKGROUND

Patient blood management (PBM) programs are associated with improved patient outcomes, reduced transfusions and costs. In 2008, the Western Australia Department of Health initiated a comprehensive health-system-wide PBM program. This study assesses program outcomes.

STUDY DESIGN AND METHODS

This was a retrospective study of 605,046 patients admitted to four major adult tertiary-care hospitals between July 2008 and June 2014. Outcome measures were red blood cell (RBC), fresh-frozen plasma (FFP), and platelet units transfused; single-unit RBC transfusions; pretransfusion hemoglobin levels; elective surgery patients anemic at admission; product and activity-based costs of transfusion; in-hospital mortality; length of stay; 28-day all-cause emergency readmissions; and hospital-acquired complications.

RESULTS

Comparing final year with baseline, units of RBCs, FFP, and platelets transfused per admission decreased 41% (p < 0.001), representing a saving of AU$18,507,092 (US$18,078,258) and between AU$80 million and AU$100 million (US$78 million and US$97 million) estimated activity-based savings. Mean pretransfusion hemoglobin levels decreased 7.9 g/dL to 7.3 g/dL (p < 0.001), and anemic elective surgery admissions decreased 20.8% to 14.4% (p = 0.001). Single-unit RBC transfusions increased from 33.3% to 63.7% (p < 0.001). There were risk-adjusted reductions in hospital mortality (odds ratio [OR], 0.72; 95% confidence interval [CI], 0.67-0.77; p < 0.001), length of stay (incidence rate ratio, 0.85; 95% CI, 0.84-0.87; p < 0.001), hospital-acquired infections (OR, 0.79; 95% CI, 0.73-0.86; p < 0.001), and acute myocardial infarction-stroke (OR, 0.69; 95% CI, 0.58-0.82; p < 0.001). All-cause emergency readmissions increased (OR, 1.06; 95% CI, 1.02-1.10; p = 0.001).

CONCLUSION

Implementation of a unique, jurisdiction-wide PBM program was associated with improved patient outcomes, reduced blood product utilization, and product-related cost savings.

摘要

背景

患者血液管理（PBM）项目与改善患者预后、减少输血及降低成本相关。2008年，西澳大利亚卫生部启动了一项全卫生系统范围的综合性PBM项目。本研究评估该项目的成果。

研究设计与方法

这是一项回顾性研究，研究对象为2008年7月至2014年6月期间入住四家主要成人三级医疗机构的605,046例患者。观察指标包括红细胞（RBC）、新鲜冰冻血浆（FFP）和血小板输注单位数；单单位RBC输注；输血前血红蛋白水平；择期手术入院时贫血的患者；基于产品和活动的输血成本；住院死亡率；住院时间；28天全因急诊再入院率；以及医院获得性并发症。

结果

与基线期相比，末期每次入院的RBC、FFP和血小板输注单位数减少了41%（p<0.001），节省了18,507,092澳元（18,078,258美元），估计基于活动的节省在8000万至1亿澳元之间（7800万至9700万美元）。输血前平均血红蛋白水平从7.9 g/dL降至7.3 g/dL（p<0.001），择期手术入院时贫血患者比例从20.8%降至14.4%（p=0.001）。单单位RBC输注比例从33.3%增至63.7%（p<0.001）。经风险调整后，住院死亡率降低（优势比[OR]，0.72；95%置信区间[CI]，0.67-0.77；p<0.001），住院时间缩短（发病率比，0.85；95%CI，0.84-0.87；p<0.001），医院获得性感染减少（OR，0.79；95%CI，0.73-0.86；p<0.001），急性心肌梗死-中风减少（OR，0.69；95%CI，0.58-0.82；p<0.001）。全因急诊再入院率增加（OR，1.06；95%CI，1.02-1.10；p=0.001）。