质量改善干预措施的成本效益分析,以增加偏好的平衡液体处方
Michelle C Spiegel1,2, Kit N Simpson3, Annie N Simpson3
1Division of Pulmonary, Critical Care, Allergy, and Sleep Medicine, Department of Medicine, Medical University of South Carolina, Charleston, SC, USA. Spiegel@MUSC.edu.
在医院实施平衡液体改善了患者的脏结果,降低了死亡率,从而大大节省了成本. 这种质量改善干预表明了基于证据的液体处方的经济效益.
科学领域:
- 腎臟病學 (nephrology) 是一種醫學.
- 关键护理医学 关键护理医学
- 卫生经济学 卫生经济学
背景情况:
- 从历史上看,由于成本,人们更喜欢正常盐水 (NS),尽管有证据支持平衡液体.
- 最近的试验表明,平衡的液体可以减少住院和重症患者的脏不良事件和死亡率.
- 一项旨在提高平衡流体使用的质量改进 (QI) 干预措施,显示平衡流体订单大幅增加.
研究的目的:
- 评估促进平衡液体处方的QI干预措施的经济影响.
- 评估平衡液体与NS的临床结果和成本效益.
主要方法:
- 一个决策树模型分析了30,000名普通成年患者和1,290名危急性败血症患者的成本和临床结果.
- 使用了来自临床试验的数据,之前的QI干预和当地成本数据.
- 评估结果包括急性损伤 (AKI),替代疗法 (RRT) 和从医院角度看的死亡率.
主要成果:
- 智商干预模拟预测避免了53次AKI,2次RRT和62次死亡,一般群体每年净节省704,507美元.
- 对于重症败血症患者来说,避免了32次AKI,4次RRT和12次死亡,节省了474,676.6美元.
- 灵敏度分析证实了每年可观的成本节约,从77,677美元到414,872.2美元.
结论:
- 预计QI干预措施将改善患者的治疗结果,并节省大量的成本.
- 增加均衡液体的处方,以证据为依据,是具有成本效益的,尽管液体成本略高,但应实施.
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