Improving Appropriate Use of Peripherally Inserted Central Catheters Through a Statewide Collaborative Hospital...

Area of Science:

• Healthcare Economics
• Quality Improvement Science
• Infection Control

Background:

• Quality improvement (QI) programs necessitate considerable financial investment.
• Evaluating the cost-effectiveness of physician-led, performance-incentivized QI interventions is crucial for healthcare sustainability.

Purpose of the Study:

• To assess the economic impact of a QI intervention aimed at increasing appropriate peripherally inserted central catheter (PICC) use.
• To determine the cost-effectiveness of reducing PICC-related complications through a large-scale QI initiative.

Main Methods:

• Economic evaluation from a healthcare sector perspective, including implementation costs (incentives, data abstraction, coordination).
• Propensity score-matched analysis comparing pre-intervention (2015-2016) and intervention (2017-2021) periods for complication rates (VTE, CLABSI, occlusion).
• Cost-effectiveness presented as cost-offset per averted complication.

Main Results:

• PICC complications significantly decreased: CLABSIs (2.1% to 1.5%), VTEs (3.2% to 2.3%), and catheter occlusions (10.8% to 7.0%).
• An estimated 871 CLABSIs, 2,535 VTEs, and 8,743 catheter occlusions were prevented.
• Project costs were $31.8 million, with a cost-offset of $64.4 million from avoided complications, yielding an average hospital cost-offset of $932,073 over seven years.

Conclusions:

• A large-scale, multihospital QI initiative targeting appropriate PICC use demonstrated significant cost-effectiveness.
• The intervention generated a substantial return on investment through the cost-offset of prevented complications.
• Physician-led, performance-incentivized QI programs can be financially beneficial in healthcare settings.