Value of hospital resources for effective pressure injury prevention: a cost-effectiveness analysis

ObjectiveHospital-acquired pressure injuries are localised skin injuries that cause significant mortality and are costly. Nursing best practices prevent pressure injuries, including time-consuming, complex tasks that lack payment incentives. The Braden Scale is an evidence-based stratification tool...

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Published in:BMJ quality & safety Vol. 28; no. 2; pp. 132 - 141
Main Authors: Padula, William V, Pronovost, Peter J, Makic, Mary Beth F, Wald, Heidi L, Moran, Dane, Mishra, Manish K, Meltzer, David O
Format: Journal Article
Language:English
Published: England BMJ Publishing Group LTD 01.02.2019
BMJ Publishing Group
Subjects:
Cost analysis
Cost of Illness
Cost-Benefit Analysis
Economics, Hospital - statistics & numerical data
Guideline Adherence
Health care
Health care policy
Health risks
Hospital Costs - statistics & numerical data
Hospitals
Hospitals - statistics & numerical data
Humans
Injuries
Injury prevention
Longitudinal Studies
Machine Learning
Markov Chains
Medicare
Models, Economic
Nursing care
Original Research
Patient safety
Practice Guidelines as Topic
Pressure Ulcer - economics
Pressure Ulcer - nursing
Pressure Ulcer - prevention & control
Pressure ulcers
Quality of care
Quality-Adjusted Life Years
Risk Assessment
Sensitivity analysis
United States
Wound healing
United States
United States > US
cost-effectiveness
health services research
nurses
ISSN:2044-5415, 2044-5423, 2044-5423
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Summary:ObjectiveHospital-acquired pressure injuries are localised skin injuries that cause significant mortality and are costly. Nursing best practices prevent pressure injuries, including time-consuming, complex tasks that lack payment incentives. The Braden Scale is an evidence-based stratification tool nurses use daily to assess pressure-injury risk. Our objective was to analyse the cost-utility of performing repeated risk-assessment for pressure-injury prevention in all patients or high-risk groups.DesignCost-utility analysis using Markov modelling from US societal and healthcare sector perspectives within a 1-year time horizon.SettingPatient-level longitudinal data on 34 787 encounters from an academic hospital electronic health record (EHR) between 2011 and 2014, including daily Braden scores. Supervised machine learning simulated age-adjusted transition probabilities between risk levels and pressure injuries.ParticipantsHospitalised adults with Braden scores classified into five risk levels: very high risk (6–9), high risk (10–11), moderate risk (12–14), at-risk (15–18), minimal risk (19–23).InterventionsStandard care, repeated risk assessment in all risk levels or only repeated risk assessment in high-risk strata based on machine-learning simulations.Main outcome measuresCosts (2016 $US) of pressure-injury treatment and prevention, and quality-adjusted life years (QALYs) related to pressure injuries were weighted by transition probabilities to calculate the incremental cost-effectiveness ratio (ICER) at $100 000/QALY willingness-to-pay. Univariate and probabilistic sensitivity analyses tested model uncertainty.ResultsSimulating prevention for all patients yielded greater QALYs at higher cost from societal and healthcare sector perspectives, equating to ICERs of $2000/QALY and $2142/QALY, respectively. Risk-stratified follow-up in patients with Braden scores <15 dominated standard care. Prevention for all patients was cost-effective in >99% of probabilistic simulations.ConclusionOur analysis using EHR data maintains that pressure-injury prevention for all inpatients is cost-effective. Hospitals should invest in nursing compliance with international prevention guidelines.
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ISSN:2044-5415
2044-5423
2044-5423
DOI:10.1136/bmjqs-2017-007505