背景:镇静管理,镇痛,谵妄影响发病率,死亡率,和重症监护患者的生活质量。将质量指标作为质量管理和保证计划的一部分进行评估是确保过程质量的既定方法。目前,关于评估质量指标对经济成果的影响的研究有限。该研究的目的是调查镇静管理指标的依从性,镇痛和谵妄,并探讨对医院经济学和临床结局的潜在影响。
方法:在这项回顾性队列研究中,我们分析了来自三级大学医院信息系统的20,220份患者记录的常规数据,从2012年1月至2019年12月收集。我们比较了两个预定义的亚组,这些亚组在疾病严重程度评分等因素方面具有高指标依从性或低指标依从性,合并症,和结果措施。我们使用逻辑回归模型来检验质量指标依从性对经济指标的影响,如诊断相关群体(DRG)收入、收入利润率,和成本,和临床结果。此外,我们使用倾向评分匹配来探究我们的发现.
结果:该队列的总收入利润率为负(-320欧元)。与低依从性(-482欧元)相比,对质量指标的高依从性与正的收入利润率(+197欧元)相关。较高的依从性也与较低的成本相关。此外,高依从性与死亡率降低(OR0.84,95%CI0.75~0.95)以及机械通气时间和住院时间缩短(分别为17小时和1天)相关.
结论:对镇静质量指标的依从性更高,镇痛,谵妄管理与经济效益和成本相关。我们还发现与死亡率降低和住院时间缩短有关。对这些关联的进一步研究可能有助于在不增加资源使用的情况下确定质量改进的机会。
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).
CONCLUSIONS: 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.