Barakat-Johnson Michelle, Lai Michelle, Wand Timothy, White Kathryn, De Abreu Lourenco Richard
Sydney Local Health District Executive Nursing, Royal Prince Alfred Hospital, Missenden Road, Camperdown, NSW 2050, Australia; and Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, University of Sydney, Mallet Street, Camperdown, NSW 2050, Australia. Email:
Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, University of Sydney, Mallet Street, Camperdown, NSW 2050, Australia. Email:
Aust Health Rev. 2019 Oct;43(5):516-525. doi: 10.1071/AH18131.
Objectives The aims of this study were to determine the costs of hospital-acquired pressure injuries (HAPIs) in one local health district in Australia and compare the costs and consequences of an intervention-based program with current practice to reduce HAPI incidence and prevalence. Methods A retrospective cost-consequence analysis was conducted using HAPI incidence rate per occupied bed days, point prevalence rates, Australian Refined-Diagnosis Related Group (AR-DRG) costs and the costs of the program to reduce the HAPI rate. Data were analysed for two phases: preprogram implementation (1 June 2015-1 June 2016) and postprogram implementation (1 August 2016-31 July 2017). Results The HAPI intervention-based program resulted in a 51.4% reduction in the incidence of HAPI (from 1.46 per occupied bed day in 2014 to 0.71 per occupied bed day in 2017) and a 71.6% reduction in the prevalence of HAPI (from 6.7% in 2014 to 1.9% in 2017). The occurrence of HAPI added an average cost of A$3332 per episode, such that the overall program, including implementation, reduced costs by A$837387. The greatest cost reduction was due to the cessation of washable and disposable underpads. The largest contributor to the cost of HAPI prevention was for education and training regarding HAPI prevention initiatives. Conclusions The HAPI intervention-based program halved the incidence and substantially reduced the prevalence of HAPI, with a 23.1% cost saving compared with the previous approach to preventing HAPIs. What is known about the topic? HAPIs are costly to the individual, the organisation and health system. The prevention of HAPIs is a priority in Australia. There is limited research on the economic effect of HAPIs and the costs and consequences for hospitals of implementation strategies to reduce their incidence. What does this paper add? This paper informs health policy and decision makers about the costs and consequences for a local health district of a program to reduce and prevent HAPIs. This paper reports the economic effect of HAPIs, including hospital episode costs per HAPI and length of stay, on one local health district. What are the implications for practitioners? This cost-consequence analysis has shown that the program to reduce HAPIs resulted in a reduction in expenditure and positive patient outcomes. Such a program is potentially transferable to other healthcare settings.
目的 本研究旨在确定澳大利亚一个地方卫生区医院获得性压疮（HAPI）的成本，并将基于干预的项目与现行做法在降低HAPI发生率和患病率方面的成本及后果进行比较。方法 使用每占用床日的HAPI发生率、时点患病率、澳大利亚细化诊断相关组（AR-DRG）成本以及降低HAPI发生率项目的成本进行回顾性成本-后果分析。对两个阶段的数据进行了分析：项目实施前（2015年6月1日至2016年6月1日）和项目实施后（2016年8月1日至2017年7月31日）。结果 基于HAPI干预的项目使HAPI发生率降低了51.4%（从2014年的每占用床日1.46例降至2017年的每占用床日0.71例），HAPI患病率降低了71.6%（从2014年的6.7%降至2017年的1.9%）。每例HAPI的发生平均增加成本3332澳元，因此包括实施在内的整个项目成本降低了837387澳元。成本降低最多的原因是可洗和一次性床垫的停用。预防HAPI成本的最大组成部分是关于HAPI预防举措的教育和培训。结论 基于HAPI干预的项目使HAPI发生率减半，并大幅降低了患病率，与之前预防HAPI的方法相比节省了23.1%的成本。关于该主题已知的情况是什么？HAPI对个人、组织和卫生系统来说成本高昂。在澳大利亚，预防HAPI是一项优先事项。关于HAPI的经济影响以及降低其发生率的实施策略对医院的成本和后果的研究有限。本文补充了什么？本文向卫生政策制定者和决策者通报了一个降低和预防HAPI项目对一个地方卫生区的成本和后果。本文报告了HAPI对一个地方卫生区的经济影响，包括每例HAPI的医院诊疗成本和住院时间。对从业者有何启示？这项成本-后果分析表明，降低HAPI的项目导致了支出的减少和积极的患者结局。这样的项目有可能推广到其他医疗环境。
