Abstract:ObjectivesTo measure and assess the economic impact of adherence to a single quality indicator (QI) regarding weaning from invasive ventilation.DesignRetrospective observational single-centre study, based on electronic medical and administrative records.SettingIntensive care unit (ICU) of a German university hospital, reference centre for acute respiratory distress syndrome.ParticipantsRecords of 3063 consecutive mechanically ventilated patients admitted to the ICU between 2012 and 2017 were extracted, of whom… Show more
Background
Management of sedation, analgesia, and delirium influences morbidity, mortality, and quality of life in patients treated in intensive care. Assessing quality indicators as part of a quality management and assurance program is an established method to ensure process quality. Currently, there is limited research on the effect of evaluating quality indicators on economic outcomes. The aim of the study was to investigate the adherence to an indicator on management of sedation, analgesia and delirium, and explore potential effects on hospital economics and clinical outcomes.
Methods
In this retrospective cohort study, we analyzed routine data from 20,220 patient records from the hospital information system of a tertiary university hospital, collected from January 2012 to December 2019. We compared two predefined subgroups with either high indicator adherence or low indicator adherence regarding factors like disease severity scores, comorbidities, and outcome measures. We used logistic regression models to examine the influence of quality indicator adherence on economic measures such as Diagnosis-related group (DRG) incomes, revenue margins, and costs, and clinical outcomes. Additionally, we used propensity score matching to probe our findings.
Results
Overall revenue margins in this cohort were negative (-320€). High adherence to the quality indicator was associated with a positive revenue margin (+197€) compared to low adherence (-482€). Higher adherence was also associated with lower costs. Additionally, high adherence was associated with reduced mortality (OR 0.84, 95% CI 0.75–0.95) and reduced duration of mechanical ventilation and hospital stay (17 hours and 1 day respectively).
Conclusion
Higher adherence to a quality indicator for sedation, analgesia, and delirium management was associated with economic returns and costs. We also found an association with lower mortality and reduced length of stay. Further research on these associations may help identify opportunities for quality improvement without increased resource use.
Background
Management of sedation, analgesia, and delirium influences morbidity, mortality, and quality of life in patients treated in intensive care. Assessing quality indicators as part of a quality management and assurance program is an established method to ensure process quality. Currently, there is limited research on the effect of evaluating quality indicators on economic outcomes. The aim of the study was to investigate the adherence to an indicator on management of sedation, analgesia and delirium, and explore potential effects on hospital economics and clinical outcomes.
Methods
In this retrospective cohort study, we analyzed routine data from 20,220 patient records from the hospital information system of a tertiary university hospital, collected from January 2012 to December 2019. We compared two predefined subgroups with either high indicator adherence or low indicator adherence regarding factors like disease severity scores, comorbidities, and outcome measures. We used logistic regression models to examine the influence of quality indicator adherence on economic measures such as Diagnosis-related group (DRG) incomes, revenue margins, and costs, and clinical outcomes. Additionally, we used propensity score matching to probe our findings.
Results
Overall revenue margins in this cohort were negative (-320€). High adherence to the quality indicator was associated with a positive revenue margin (+197€) compared to low adherence (-482€). Higher adherence was also associated with lower costs. Additionally, high adherence was associated with reduced mortality (OR 0.84, 95% CI 0.75–0.95) and reduced duration of mechanical ventilation and hospital stay (17 hours and 1 day respectively).
Conclusion
Higher adherence to a quality indicator for sedation, analgesia, and delirium management was associated with economic returns and costs. We also found an association with lower mortality and reduced length of stay. Further research on these associations may help identify opportunities for quality improvement without increased resource use.
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