Abstract
BackgroundA quality improvement collaborative (QIC) in the Dutch long-term care sector (nursing homes, assisted living facilities, home care) used evidence-based prevention methods to reduce the incidence and prevalence of pressure ulcers (PUs). The collaborative consisted of a core team of experts and 25 organizational project teams. Our aim was to determine its cost-effectiveness from a healthcare perspective.MethodsWe used a non-controlled pre-post design to establish the change in incidence and prevalence of PUs in 88 patients over the course of a year. Staff indexed data and prevention methods (activities, materials). Quality of life (Qol) weights were assigned to the PU states. We assessed the costs of activities and materials in the project. A Markov model was built based on effectiveness and cost data, complemented with a probabilistic sensitivity analysis. To illustrate the results of longer term, three scenarios were created in which change in incidence and prevalence measures were (1) not sustained, (2) partially sustained, and (3) completely sustained.ResultsIncidence of PUs decreased from 15% to 4.5% for the 88 patients. Prevalence decreased from 38.6% to 22.7%. Average Quality of Life (Qol) of patients increased by 0.02 Quality Adjusted Life Years (QALY)s in two years; healthcare costs increased by €2000 per patient; the Incremental Cost-effectiveness Ratio (ICER) was between 78,500 and 131,000 depending on whether the changes in incidence and prevalence of PU were sustained.ConclusionsDuring the QIC PU incidence and prevalence significantly declined. When compared to standard PU care, the QIC was probably more costly and more effective in the short run, but its long-term cost-effectiveness is questionable. The QIC can only be cost-effective if the changes in incidence and prevalence of PU are sustained.
Highlights
A quality improvement collaborative (QIC) in the Dutch long-term care sector used evidence-based prevention methods to reduce the incidence and prevalence of pressure ulcers (PUs)
Several studies have been published on the cost-effectiveness of the materials for PU treatment and prevention [7,17,18,19], and the one study we found that focused on labor costs [20] considered only nurse staffing time and disregarded preventive activities
The aim of this article is to answer the question: Was this PU QIC cost-effective when compared to standard PU care?
Summary
A quality improvement collaborative (QIC) in the Dutch long-term care sector (nursing homes, assisted living facilities, home care) used evidence-based prevention methods to reduce the incidence and prevalence of pressure ulcers (PUs). A pressure ulcer (PU) is a preventable condition that affects patients with impaired mobility, especially the elderly [1]. PUs are classified from grades 1 to 4, or least to most severe. The average prevalence of PUs in the Netherlands is 7.9% in assisted living homes and 18.3% in nursing homes [2]. Incidence varies between 2.9% and 4.5% in intensive care [3]. No incidence data are available for the Dutch long-term care sector. The probability of healing within 90 days varies with severity: 67% (grade 2), 44% (grade 3) and 32% (grade 4) [4]. According to a study by Franks [6] the quality of life of PU patients is no worse than the general population of nurs-
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