电子监测与手动纸质监测在手卫生依从性方面的比较：一项全面的健康经济评估分析。
Electronic monitoring versus manual paper-based monitoring for hand hygiene compliance: a comprehensive health economic assessment analysis.
机构信息
Nursing Department of Zhongnan Hospital of Wuhan University, Wuhan, Hubei, China.
School of Public Health and Management, Hubei University of Medicine, Shiyan, Hubei, China.
出版信息
BMC Health Serv Res. 2024 Sep 27;24(1):1126. doi: 10.1186/s12913-024-11591-y.
BACKGROUND
Monitoring hand hygiene compliance (HHC) of healthcare providers (HCPs) in healthcare facilities is critical for hand hygiene (HH) promotion. However, less is known about the cost and effectiveness of different HHC monitoring tools. In this study, we aimed to compare various health economic indicators corresponding to electronic system-based monitoring (ESM) and manual paper-based monitoring (MPM) for HHC to provide evidence-based advice for HHC monitoring measures targeted selecting.
METHODS
A before and after study in 40 clinical departments with 4,524 healthcare providers was conducted from December 2022 to January 2023 (MPM implementation phase) and March 2023 to May 2023 (ESM implementation phase). The cost-effectiveness, cost-efficiency, the extent of the Hawthorne effect, and indirect cost-benefit of the two monitoring methods were compared.
RESULTS
The total cost spent on ESM for the 40 departments (17,702.92 CNY) was 4,123.76 CNY lower than that of MPM (21,826.68 CNY). The HHC of MPM (80.16%) was higher than that of ESM (69.82%) (p < 0.01). In high- and medium-risk departments, the cost-effectiveness ratio of ESM (7,977.90 CNY and 13,794.60 CNY, respectively) was lower than that of MPM (9,039.61 CNY and 14,549.05 CNY, respectively). In low-risk departments, the cost-effectiveness ratio of ESM (3,910.77 CNY) was higher than that of MPM (3,899.06 CNY). Compared with ESM, the incremental cost of MPM in all departments was 4,123.76 CNY, the incremental effectiveness was 10.34%, and the incremental cost-effectiveness ratio was 39,881.62 CNY. Between the two monitoring methods, the efficiency of ESM (48.11%) in all departments was higher than that of MPM (14.20%) (p < 0.01). The cost-efficiency ratio of MPM in all departments (155,775.56 CNY) was higher than that of ESM (36,796.76 CNY). The extent of Hawthorne effect of MPM of HHC in all departments (43.99%) was higher than that of ESM (35.69%) (p < 0.01). When ESM was used as the HHC monitoring approach, the HAI rates (1.39%) in all departments were higher than that when MPM was used (1.34%) (p = 0.562). When the payment willingness was less than 40,000 CNY, the ESM method was the better option for cost-effectiveness; When the input exceeded this threshold, the MPM method was the better option for cost-effectiveness.
CONCLUSIONS
ESM exhibited notable advantages over MPM in terms of cost-effectiveness, cost-efficiency, cost-benefit, and the Hawthorne effect.
背景
监测医疗保健提供者（HCP）在医疗机构中的手卫生依从性（HHC）对于手卫生（HH）的推广至关重要。然而，对于不同的 HHC 监测工具的成本和效果知之甚少。在这项研究中，我们旨在比较电子系统监测（ESM）和手动纸质监测（MPM）两种 HHC 监测方法的各种健康经济指标，为有针对性地选择 HHC 监测措施提供循证建议。
方法
在 2022 年 12 月至 2023 年 1 月（MPM 实施阶段）和 2023 年 3 月至 5 月（ESM 实施阶段）期间，对 40 个临床科室的 4524 名医护人员进行了一项前后对照研究。比较了两种监测方法的成本效益、成本效率、霍桑效应程度和间接成本效益。
结果
40 个科室的 ESM 总花费（17702.92 元）比 MPM（21826.68 元）低 4123.76 元。MPM 的 HHC（80.16%）高于 ESM（69.82%）（p<0.01）。在高、中风险科室，ESM 的成本效益比（分别为 7977.90 元和 13794.60 元）低于 MPM（分别为 9039.61 元和 14549.05 元）。在低风险科室，ESM 的成本效益比（3910.77 元）高于 MPM（3899.06 元）。与 ESM 相比，所有科室 MPM 的增量成本为 4123.76 元，增量效果为 10.34%，增量成本效益比为 39881.62 元。在两种监测方法中，ESM 在所有科室的效率（48.11%）均高于 MPM（14.20%）（p<0.01）。所有科室 MPM 的成本效率比（155775.56 元）高于 ESM（36796.76 元）。所有科室 MPM 的霍桑效应程度（43.99%）高于 ESM（35.69%）（p<0.01）。当使用 ESM 作为 HHC 监测方法时，所有科室的 HAI 率（1.39%）高于使用 MPM 时的 HAI 率（1.34%）（p=0.562）。当支付意愿低于 40000 元时，ESM 方法在成本效益方面更具优势；当投入超过这一门槛时，MPM 方法在成本效益方面更具优势。
结论
与 MPM 相比，ESM 在成本效益、成本效率、成本效益和霍桑效应方面具有显著优势。
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