Marginal Costs of Hospital-Acquired Conditions: Information for Priority-Setting for Patient Safety Programmes and Research

Jackson, Terri; Nghiem, Son; Rowell, David; Jorm, Christine; Wakefield, John

doi:10.1258/jhsrp.2010.010050

Cited by 53 publications

(71 citation statements)

References 18 publications

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“…A wide range of prevalence rates has been reported in Australia, from as low as 0.2% in the study of Jackson et al 33 to 17.6% in the Western Australia Wound Prevalence Survey. 10 To incorporate uncertainty around the true prevalence, we fitted a beta distribution, which is suitable for parameters bounded by 0 and 1, using the minimum (0.2%) and maximum (17.6%) values reported in the Australian literature.…”

Section: Number Of Patients With Pi Casesmentioning

confidence: 99%

“…10 To incorporate uncertainty around the true prevalence, we fitted a beta distribution, which is suitable for parameters bounded by 0 and 1, using the minimum (0.2%) and maximum (17.6%) values reported in the Australian literature. 1,7,[32][33][34]38,39 The number of cases with PI was then calculated as the product of the estimated prevalence rate and the number of in-patient cases (discharges), sourced from Australian hospital statistics 2012-13. 43 …”

Section: Number Of Patients With Pi Casesmentioning

confidence: 99%

“…Based on data from 2005-06 (Victoria) and 2006-07 (Queensland), Jackson et al reported the total number of PI cases to be 2873, representing a prevalence of 0.2% (much lower than the prevalence estimated in other studies 1,34,35 ) and a total cost of A$22.9 million for the public hospitals in these two states. 33 It is noted that this prevalence rate, and thus estimated cost, was likely to be underestimated. Jackson et al 33 derived the estimates from data collected retrospectively using the Diagnosis-Related Group (DRG) system, whereas the state reports 1,34,35 estimated their prevalence rates from prospective prevalence surveys where PI was recorded through direct skin inspection, which was more likely to be more accurate.…”

mentioning

confidence: 99%

“…33 It is noted that this prevalence rate, and thus estimated cost, was likely to be underestimated. Jackson et al 33 derived the estimates from data collected retrospectively using the Diagnosis-Related Group (DRG) system, whereas the state reports 1,34,35 estimated their prevalence rates from prospective prevalence surveys where PI was recorded through direct skin inspection, which was more likely to be more accurate. Antonio and Conrad 36 presented an evaluation of the Wound Care Improvement program in the Ballarat Health Service (Victoria), in which prevalence data by PI stage were collected for 2009, 2011 and 2012.…”

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confidence: 99%

“…Graves et al estimated the impact of PI on in-patient LOS, as well as the opportunity cost of bed days lost using 2001-02 data. 19,32 Jackson et al 33 reported that PI ranked among the top five hospital-acquired complications (by total additional system cost). Based on data from 2005-06 (Victoria) and 2006-07 (Queensland), Jackson et al reported the total number of PI cases to be 2873, representing a prevalence of 0.2% (much lower than the prevalence estimated in other studies 1,34,35 ) and a total cost of A$22.9 million for the public hospitals in these two states.…”

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confidence: 99%

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Pressure injury in Australian public hospitals: a cost-of-illness study

Nguyen

Chaboyer²,

Whitty

2015

Aust. Health Review

144

102

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Objective. Pressure injuries (PI) are largely preventable and can be viewed as an adverse outcome of a healthcare admission, yet they affect millions of people and consume billions of dollars in healthcare spending. The existing literature in Australia presents a patchy picture of the economic burden of PI on society and the health system. The aim of the present study was to provide a more comprehensive and updated picture of PI by state and severity using publicly available data.Methods. A cost-of-illness analysis was conducted using a prevalence approach and a 1-year time horizon based on data from the existing literature extrapolated using simulation methods to estimate the costs by PI severity and state subgroups.Results. The treatment cost across all states and severity in 2012-13 was estimated to be A$983 million per annum, representing approximately 1.9% of all public hospital expenditure or 0.6% of the public recurrent health expenditure. The opportunity cost was valued at an additional A$820 million per annum. These estimates were associated with a total number of 121 645 PI cases in 2012-13 and a total number of 524 661 bed days lost.Conclusions. The costs estimated in the present study highlight the economic waste for the Australian health system associated with a largely avoidable injury. Wastage can also be reduced by preventing moderate injuries (Stage I and II) from developing into severe cases (Stage III and IV), because the severe cases, accounting for 12% of cases, mounted to 30% of the total cost. What is known about the topic?The literature has identified that in the Australian health care system, wound management is one of the most frequently performed procedures. However, the overall economic cost of PI to the public hospital system is largely unknown. What does this paper add? This study provides reliable estimates, based predominantly on Australian data, of the number of cases and treatment costs associated with PI in public hospitals, disaggregated by state and severity. The paper also attempts to quantify the opportunity cost of PI, which leads to extra hospital length of stay. The estimated costs give an indication of the economic waste to the health system due to avoidable injury. What are the implications for practitioners? This study is relevant and important in the context of rising healthcare costs. It highlights an area for potential improvement in quality of care (i.e. better hospital experience for patients) and efficiency (i.e. reducing economic waste) in the hospital sector. It also reveals the paucity of data available to support cost estimation, from the prevalence and incidence rates to the treatment cost by disease severity, which further highlights an under-researched area.

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Section: Number Of Patients With Pi Casesmentioning

confidence: 99%

Section: Number Of Patients With Pi Casesmentioning

confidence: 99%

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confidence: 99%

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confidence: 99%

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confidence: 99%

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Pressure injury in Australian public hospitals: a cost-of-illness study

Nguyen

Chaboyer²,

Whitty

2015

Aust. Health Review

144

102

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Transforming Hospital Accreditation: From Assurance to Improvement

Duckett¹,

Jorm²

2019

Hospital Transformation

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Patientensicherheit

Schrappe

2014

Bundesgesundheitsbl.

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Almost 10 years ago, the German Coalition for Patient Safety (Aktionsbündnis Patientensicherheit) was founded as a cooperation covering most institutions of the German health care system. As in other countries facing the issue of patient safety, methods for the analysis of "never events" have been developed, instruments for the identification of the "unknown unknowns" have been established (e.g., CIRS), and the paradigm of individual blame has been replaced by organizational, team and management factors. After these first steps, further developments can only be achieved in so far as patient safety is understood as a system property, which leads to specific implications for the further evolution of the healthccare system. The "patient safety movement" has to participate in this discussion in order to avoid misuse of the patient safety concept as a defensive means, merely confined to overcome the adverse events of payment and structural incentives (e.g., diagnosis related groups in the inpatient sector). Because the dominant requirements for the future healthcare system consist of care for an elderly population with chronic and multiple diseases, the focus has to be shifted away from acute and surgical procedures and diseases, as given in the present quality assurance programs in Germany, to prevention and coordination of chronic care. Efforts to improve drug and medication safety of elderly people can be regarded as perfect examples, but other efforts are still missing. Second, the structural problems as the sector-associated optimization of care should be addressed, because typical safety issues are not limited to single sectors but represent problems of missing integration and suboptimal population care (e.g., MRSA). In the third line, the perspectives of society and institutions on safety (and quality of care) must urgently be enlarged to the perspectives of patients on the one hand and the benefit of treatments (e.g., overuse) on the other hand. All these issues are only to be implemented as far as the general societal attitude supportings further improvement of patient safety and is ready to regard it as a major aim for future developments. Cost arguments alone - costs of suboptimal safety can be estimated to around 1 billion in Germany per year - are considered as insufficient to guarantee further improvements because other issues in the healthcare system show similar magnitudes. As a consequence, ethical implications remain as major arguments for ongoing professional and public discussions.

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Marginal Costs of Hospital-Acquired Conditions: Information for Priority-Setting for Patient Safety Programmes and Research

Cited by 53 publications

References 18 publications

Pressure injury in Australian public hospitals: a cost-of-illness study

Pressure injury in Australian public hospitals: a cost-of-illness study

Transforming Hospital Accreditation: From Assurance to Improvement

Patientensicherheit

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