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首页> 外文期刊>Journal of patient safety >Modeling for the decision process to implement an educational intervention: an example of a central venous catheter insertion course.
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Modeling for the decision process to implement an educational intervention: an example of a central venous catheter insertion course.

机译：确定教育干预的决策过程建模：中央静脉导管插入课程的一个例子。

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INTRODUCTION: The Center for Medicare and Medicaid Services recently declared that central venous catheter-associated bloodstream infections (CLABs) are preventable and no longer reimbursable. The new penalty paradigm creates substantial economic incentives for hospitals to eliminate infections. Modeling exercises offer the opportunity to justify expenditures for the prevention of rare patient safety events. METHODS: We constructed a decision analytic model of the theoretical impact of an educational intervention to improve the safety of central venous catheter insertion. This methodology allows for decision nodes representing procedure urgency, procedure locations, and effects of education on both infectious and mechanical complications. We performed deterministic sensitivity analyses to estimate effects of changes in complication rates, educational impact, and cost. RESULTS: In an already safety system (CLAB rate of 1:1000 line days or 0.7%), the initial sensitivity results suggest that if education results in a 50% reduction in CLAB and a 25% reduction in mechanical complications, survival is equal, and cost is increased by Dollars 92,400 in a large hospital system annually. If all CLAB and mechanical complications are eliminated, survival improves slightly, and cost is reduced by Dollars 64,800 annually. CONCLUSIONS: These results suggest that if the educational intervention is effective, a small increase in cost can reduce complications. Our analysis does not consider increased revenue generated by virtual bed capacity increases or dynamic changes in practice. This model serves as a template for other health care institutions to estimate the costs and benefits of their own proposed educational interventions.
机译：简介：Medicare和Medicaid Services中心最近宣称，中央静脉导管相关的血流感染（锁骨）可预防，不再偿还。新的惩罚范式为医院创造了实质性的经济激励，以消除感染。建模练习提供有机会证明预防稀有患者安全事件的支出。方法：我们构建了一种教育干预的理论影响的决策分析模型，以提高中枢静脉导管插入的安全性。该方法允许代表参数紧迫性，程序位置和教育对传染性和机械并发症的影响的决策节点。我们进行了确定性敏感性分析，以估计并发症率变化，教育影响和成本的影响。结果：在一个安全系统（锁率为1：1000线或0.7％），初始敏感性结果表明，如果教育导致锁骨减少50％和机械并发症减少25％，则存活率相等，每年大型医院系统中，成本增加了美元92,400美元。如果消除所有癌和机械并发症，生存略有提高，每年减少成本14,800美元。结论：这些结果表明，如果教育干预是有效的，成本的少量增加可以减少并发症。我们的分析不考虑虚拟床容量产生的增加的收入增加或实践中的变化。该型号作为其他医疗机构的模板，以估计其拟议的教育干预措施的成本和益处。

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