Wuhan Pulmonary Hospital/Wuhan Institute for Tuberculosis Control, No28 Baofengyilu Road, Wuhan, 430030, China.
School of Public Health/Global Health Institute, Wuhan University, No. 115 Donghu Road, Wuhan, 430071, China.
Glob Health Res Policy. 2024 Sep 9;9(1):33. doi: 10.1186/s41256-024-00375-w.
Healthcare-associated infections (HAIs) represent a major global health burden, which necessitate effective frameworks to identify potential risk factors and estimate the corresponding direct economic disease burden. In this article, we proposed a framework designed to address these needs through a case study conducted in a Tuberculosis (TB) hospital in Hubei Province, China, using data from 2018 to 2019. A comprehensive multistep procedure was developed, including ethical application, participant inclusion, risk factor identification, and direct economic disease burden estimation. In the case study, ethical approval was obtained, and patient data were anonymized to ensure privacy. All TB hospitalized patients over the study period were included and classified into groups with and without HAIs after screening the inclusion and exclusion criteria. Key risk factors, including gender, age, and invasive procedure were identified through univariate and multivariate analyses. Then, propensity score matching was employed to select the balanced groups with similar characteristics. Comparisons of medical expenditures (total medical expenditure, medicine expenditure, and antibiotics expenditure) and hospitalization days between the balanced groups were calculated as the additional direct economic disease burden measures caused by HAIs. This framework can serve as a tool for not only hospital management and policy-making, but also implementation of targeted infection prevention and control measures. Moreover, it has the potential to be applied in various healthcare settings at local, regional, national, and international levels to identify high-risk areas, optimize resource allocation, and improve hospital management and governance, as well as inter-organizational learning. Challenges to implement the framework are also raised, such as data quality, regulatory compliance, considerations on unique nature of communicable diseases and other diseases, and training need for professionals.
医疗机构相关性感染（HAIs）是一个重大的全球健康负担，需要有效的框架来识别潜在的风险因素并估计相应的直接经济疾病负担。本文提出了一个框架，通过在中国湖北省一家结核病（TB）医院进行的案例研究来满足这些需求，使用了 2018 年至 2019 年的数据。开发了一个综合的多步骤程序，包括伦理应用、参与者纳入、风险因素识别和直接经济疾病负担估计。在案例研究中，获得了伦理批准，并对患者数据进行了匿名化以确保隐私。所有在研究期间住院的结核病患者都被纳入，并在筛选纳入和排除标准后分为有和没有 HAIs 的两组。通过单变量和多变量分析确定了关键的风险因素，包括性别、年龄和侵入性操作。然后，采用倾向评分匹配选择具有相似特征的平衡组。计算平衡组之间的医疗支出（总医疗支出、药品支出和抗生素支出）和住院天数的差异，作为 HAIs 引起的额外直接经济疾病负担的衡量标准。该框架不仅可作为医院管理和决策的工具，还可用于实施有针对性的感染预防和控制措施。此外，它还有潜力在地方、区域、国家和国际各级的各种医疗保健环境中应用，以识别高风险区域、优化资源分配、改善医院管理和治理以及促进组织间学习。实施该框架还面临一些挑战，例如数据质量、监管合规性、传染病和其他疾病的独特性考虑以及专业人员的培训需求。
