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Research Studies is a monthly compilation of research articles funded by AHRQ or authored by AHRQ researchers and recently published in journals or newsletters.
Results1 to 6 of 6 Research Studies Displayed
Collinsworth AW, Priest EL, Masica AL
Evaluating the cost-effectiveness of the ABCDE bundle: impact of bundle adherence on inpatient and 1-year mortality and costs of care.
This study examined the cost-effectiveness of the Awakening and Breathing Coordination, Delirium monitoring/management, and Early exercise/mobility (ABCDE) bundle intervention to improve short- and long-term clinical outcomes for patients requiring ICU care. A 2-year, prospective, cost-effectiveness study in 12 adult ICUs in six hospitals belonging to a large, integrated healthcare delivery system was conducted. Hospitals in the study included a large, urban center and five community hospitals. ICU types included medical/surgical, trauma, neurologic, and cardiac care units. The cohort included 2,953 adults with an ICU stay greater than 24 hours who were on a ventilator for more than 24 hours and less than 14 days. ICUs with high ABCDE bundle adherence significantly decreased odds of inpatient mortality and had significantly higher costs of inpatient care. The incremental cost-effectiveness ratio of high bundle adherence was $15,077 per life saved, and $1,057 per life-year saved.
Citation: Collinsworth AW, Priest EL, Masica AL . Evaluating the cost-effectiveness of the ABCDE bundle: impact of bundle adherence on inpatient and 1-year mortality and costs of care. Crit Care Med 2020 Dec;48(12):1752-59. doi: 10.1097/ccm.0000000000004609..
Keywords: Intensive Care Unit (ICU), Critical Care, Mortality, Healthcare Costs
Khandelwal N, White L, Curtis JR
Health insurance and out-of-pocket costs in the last year of life among decedents utilizing the ICU.
The objective of this study was to estimate out-of-pocket costs in the last year of life for individuals who required intensive care in the months prior to death and to examine how these costs vary by insurance coverage. Results showed that, across all categories of insurance coverage, out-of-pocket spending in the last 12 months of life was high and represented a significant portion of assets for many patients requiring intensive care and their families. Medicare fee-for-service alone did not insulate individuals from the financial burden of high-intensity care. Medicaid was found to provide the most complete hospital coverage of all the insurance groups, as well as significantly financing long-term care.
Citation: Khandelwal N, White L, Curtis JR . Health insurance and out-of-pocket costs in the last year of life among decedents utilizing the ICU. Crit Care Med 2019 Jun;47(6):749-56. doi: 10.1097/ccm.0000000000003723..
Keywords: Critical Care, Elderly, Health Insurance, Healthcare Costs, Intensive Care Unit (ICU), Medicaid, Medicare
Mahmoud L, Zullo AR, Thompson BB
Outcomes of protocolised analgesia and sedation in a neurocritical care unit.
Researchers conducted a retrospective cohort study of 1197 mechanically ventilated patients admitted to a 12-bed neurocritical care unit (NCCU) over four years in order to evaluate the effect of an analgesia-based sedation protocol on medication use and costs in the NCCU. The protocol resulted in increased in fentanyl use and decreased in propofol use, but their findings indicate no effect on healthcare utilization, healthcare costs, or in-hospital mortality. Based on these results, the researchers suggest that similar NCCUs should consider using population-specific protocols to manage analgesia and sedation.
Citation: Mahmoud L, Zullo AR, Thompson BB . Outcomes of protocolised analgesia and sedation in a neurocritical care unit. Brain Inj 2018;32(7):941-47. doi: 10.1080/02699052.2018.1469167..
Keywords: Care Management, Brain Injury, Critical Care, Healthcare Costs, Intensive Care Unit (ICU), Medication, Neurological Disorders, Outcomes, Patient-Centered Outcomes Research, Value
Sjoding MW, Valley TS, Prescott HC
Rising billing for intermediate intensive care among hospitalized Medicare bbetween 1996 and 2010.
This study characterized trends in intermediate care use among U.S. hospitals. Only 8.2 percent of Medicare hospitalizations in 1996 were billed for intermediate care, but billing steadily increased to 22.8 percent by 2010, whereas the percentage billed for ICU care and ward-only care declined. Patients billed for intermediate care had more acute organ failures diagnoses codes compared with general ward patients.
Citation: Sjoding MW, Valley TS, Prescott HC . Rising billing for intermediate intensive care among hospitalized Medicare bbetween 1996 and 2010. Am J Respir Crit Care Med 2016 Jan 15;193(2):163-70. doi: 10.1164/rccm.201506-1252OC.
Keywords: Payment, Hospitals, Intensive Care Unit (ICU), Healthcare Costs, Medicare
Kerlin MP, Cooke CR
Understanding costs when seeking value in critical care.
The authors discuss a study by Gershengorn and colleagues about daily ICU costs in five ICUs within a single medical center. They argue that although the authors should be commended on advancing the understanding of ICU costs, we should also recognize that efforts to reduce ICU length of stay will necessarily be insufficient to make a real dent in our health care economy.
Citation: Kerlin MP, Cooke CR . Understanding costs when seeking value in critical care. Ann Am Thorac Soc 2015 Dec;12(12):1743-4. doi: 10.1513/AnnalsATS.201510-660ED.
Keywords: Critical Care, Healthcare Costs, Intensive Care Unit (ICU), Value
Huang SS, Septimus E, TR TR
Cost savings of universal decolonization to prevent intensive care unit infection: implications of the REDUCE MRSA trial.
The researchers estimated the incremental effect on healthcare costs associated with targeted decolonization and universal decolonization compared with screening and isolation, which is considered the current standard of care. They found that a strategy of universal decolonization for patients admitted to the ICU would both reduce bloodstream infections and like reduce healthcare costs when compared to other strategies.
AHRQ-funded; 290201000008I; 29032007T.
Citation: Huang SS, Septimus E, TR TR . Cost savings of universal decolonization to prevent intensive care unit infection: implications of the REDUCE MRSA trial. Infect Control Hosp Epidemiol. 2014 Oct;35 Suppl 3:S23-31. doi: 10.1086/677819..
Keywords: Healthcare Costs, Quality of Care, Healthcare-Associated Infections (HAIs), Intensive Care Unit (ICU), Patient Safety