Calculated Cost Savings Research Articles

The Cost Effectiveness of Embedding a Behavioral Health Clinician into an Existing Primary Care Practice to Facilitate the Integration of Care: A Prospective, Case-Control Program Evaluation.

This project evaluated the cost effectiveness of integrating behavioral health services into a primary care practice using a prospective, case-control design. New Directions Behavioral Health collaborated with a large Kansas City primary care practice to integrate a licensed psychologist (i.e., behavioral health clinician) into the practice. Patient claims data were examined 21 months prior to and 14 months after the psychologist began providing full-time behavioral health services within the practice. Claims data from patients with Blue Cross Blue Shield of Kansas City insurance (BCBSKC) who had at least one encounter with the psychologist (N = 239) were compared to control patients (BCBSKC fully insured patients at large) to calculate cost savings. The results demonstrated that integrating behavioral health services into the practice was associated with $860.16 per member per year savings or 10.8% savings in costs for BCBSKC patients. Integrating behavioral health services into primary care may lead to reductions in health care costs.

Abstract 232: Medication Cost Savings Using an On-line Drug Discount Program

Objective: To evaluate the frequency of drug discount card utilization and to estimate cost savings associated with heart failure (HF) medication prescriptions. Methods: We conducted a retrospective study of all HF prescriptions filled through the NeedyMeds.org drug discount card program nationwide, from January 2009 to December 2016. We evaluated the frequency of drug discount card prescriptions (across pharmacy types, pharmacy location, by prescriber specialty and by drug class) and calculated cost savings (average per drug discount card and total program dollars saved) for entire study period and for each year (from 2009 to 2016). Findings: A total of 381,347 prescriptions for medications that can be used for HF with drug discount cards were identified during the study period (83.7% at national, 5.7% at regional and 9.8% at local pharmacies). Most prescriptions were filled at urban locations (89.1% in urban clusters, 7.6% in urbanized areas) and in ZIP-codes with lower median household income (65.5%). Angiotensin-converting enzyme inhibitors and selected angiotensin receptor blockers were the most prescribed drugs with discount cards (44.1%) followed by beta blockers (27.5%), diuretics (21.5%), and mineralocorticoid receptor agonists (3.9%). The number of HF prescriptions with drug discount cards increased from 2577 in 2009 to 64,750 in 2016. Increase in the number of prescriptions was also noted for all drug classes from 2009 to 2016. Overall 224,049 prescriptions for HF medications (59% of the total) benefited from the program resulting in total savings of $4,739,204 with a median cost saving of $9.30 (41.5%) per prescription. Conclusion: Use of a drug discount program resulted in cost savings on HF prescription medications (approximately $9 in savings per prescription) compared to the original cost charged by pharmacies. While these drug assistance programs may reduce financial burden, continued efforts should be made to improve adherence to medications and for better outcomes.

Key Design Considerations When Calculating Cost Savings for Population Health Management Programs in an Observational Setting.

To illustrate the impact of key quasi-experimental design elements on cost savings measurement for population health management (PHM) programs. Population health management program records and Medicaid claims and enrollment data from December 2011 through March 2016. The study uses a difference-in-difference design to compare changes in cost and utilization outcomes between program participants and propensity score-matched nonparticipants. Comparisons of measured savings are made based on (1) stable versus dynamic population enrollment and (2) all eligible versus enrolled-only participant definitions. Options for the operationalization of time are also discussed. Individual-level Medicaid administrative and claims data and PHM program records are used to match study groups on baseline risk factors and assess changes in costs and utilization. Savings estimates are statistically similar but smaller in magnitude when eliminating variability based on duration of population enrollment and when evaluating program impact on the entire target population. Measurement in calendar time, when possible, simplifies interpretability. Program evaluation design elements, including population stability and participant definitions, can influence the estimated magnitude of program savings for the payer and should be considered carefully. Time specifications can also affect interpretability and usefulness.

Clinical effectiveness and cost-effectiveness of issuing longer versus shorter duration (3-month vs. 28-day) prescriptions in patients with chronic conditions: systematic review and economic modelling.

To reduce expenditure on, and wastage of, drugs, some commissioners have encouraged general practitioners to issue shorter prescriptions, typically 28 days in length; however, the evidence base for this recommendation is uncertain. To evaluate the evidence of the clinical effectiveness and cost-effectiveness of shorter versus longer prescriptions for people with stable chronic conditions treated in primary care. The design of the study comprised three elements. First, a systematic review comparing 28-day prescriptions with longer prescriptions in patients with chronic conditions treated in primary care, evaluating any relevant clinical outcomes, adherence to treatment, costs and cost-effectiveness. Databases searched included MEDLINE (PubMed), EMBASE, Cumulative Index to Nursing and Allied Health Literature, Web of Science and Cochrane Central Register of Controlled Trials. Searches were from database inception to October 2015 (updated search to June 2016 in PubMed). Second, a cost analysis of medication wastage associated with < 60-day and ≥ 60-day prescriptions for five patient cohorts over an 11-year period from the Clinical Practice Research Datalink. Third, a decision model adapting three existing models to predict costs and effects of differing adherence levels associated with 28-day versus 3-month prescriptions in three clinical scenarios. In the systematic review, from 15,257 unique citations, 54 full-text papers were reviewed and 16 studies were included, five of which were abstracts and one of which was an extended conference abstract. None was a randomised controlled trial: 11 were retrospective cohort studies, three were cross-sectional surveys and two were cost studies. No information on health outcomes was available. An exploratory meta-analysis based on six retrospective cohort studies suggested that lower adherence was associated with 28-day prescriptions (standardised mean difference -0.45, 95% confidence interval -0.65 to -0.26). The cost analysis showed that a statistically significant increase in medication waste was associated with longer prescription lengths. However, when accounting for dispensing fees and prescriber time, longer prescriptions were found to be cost saving compared with shorter prescriptions. Prescriber time was the largest component of the calculated cost savings to the NHS. The decision modelling suggested that, in all three clinical scenarios, longer prescription lengths were associated with lower costs and higher quality-adjusted life-years. The available evidence was found to be at a moderate to serious risk of bias. All of the studies were conducted in the USA, which was a cause for concern in terms of generalisability to the UK. No evidence of the direct impact of prescription length on health outcomes was found. The cost study could investigate prescriptions issued only; it could not assess patient adherence to those prescriptions. Additionally, the cost study was based on products issued only and did not account for underlying patient diagnoses. A lack of good-quality evidence affected our decision modelling strategy. Although the quality of the evidence was poor, this study found that longer prescriptions may be less costly overall, and may be associated with better adherence than 28-day prescriptions in patients with chronic conditions being treated in primary care. There is a need to more reliably evaluate the impact of differing prescription lengths on adherence, on patient health outcomes and on total costs to the NHS. The priority should be to identify patients with particular conditions or characteristics who should receive shorter or longer prescriptions. To determine the need for any further research, an expected value of perfect information analysis should be performed. This study is registered as PROSPERO CRD42015027042. The National Institute for Health Research Health Technology Assessment programme.

PMS9 - Cost-Savings Due To Implementation of A Screening Algorithm For Diagnosis of Rheumatoid Arthirits in Colombia

The lack of expertise in diagnosis of rheumatoid arthritis (RA) at primary level centers becomes in misdiagnosis of this condition. We implemented in Colombia at a specialized center in RA a diagnosis algorithm to achieve a correct and definitive diagnosis.The aim of this study was to describe the examination model and to find the proportion of patients with a correct diagnosis of RA when an algorithm of disease diagnosis was applied and the costs-savings associated with the accurate diagnosis of this disease. A descriptive study included patients who were referred from primary care centers with presumptive diagnosis of RA. Each patient was evaluated to confirm or rule-out diagnosis of RA as follows: a rheumatologist fulfilled a complete medical record, including physical examination and joint counts; it was assessed rheumatoid factor and anti-citrullinated antibodies, and other laboratories depending on each case. Also were made x-rays of hands and feet, and in some cases of persistent doubt about diagnosis was requested a comparative MRI or ultrasound of hands or/and feet. Between 2011 and 2016 10.716 patients were studied. With our screening model we found 46% (4.944) patients had RA and 54% (5.772) had other rheumatic diseases mainly osteoarthritis, Sjögren syndrome, systemic lupus erythematosus among others. When we calculated cost savings related to the adequate diagnosis of RA we saved in medications, medical services and diagnostic control tests per patient 1.254 USD every year and for the 5.772 patients we saved 3.591.000 USD/million dollars during a five year period. The results of this study are evidence to support the urgent need of education strategies for primary care physicians and the implementation of centers of excellence in RA in order to conduct a proper diagnose of RA and to avoid impact on health system budget

Implementation of a Preoperative Anemia Management Clinic in a Tertiary Academic Medical Center

Background:Preoperative anemia is commonly encountered with a reported incidence of 5-75% in elective presurgical populations. Anemia is an independent risk factor for perioperative morbidity and mortality and is a strong predictor of perioperative blood transfusion. Approximately 50% of all blood transfusions occur in the perioperative setting and transfusions are a significant financial burden for healthcare institutions. Although preoperative anemia management has been shown to reduce transfusion requirements and improve perioperative outcomes, the optimal delivery model for this service remains unclear. We describe the implementation of a novel preoperative anemia management clinic (AMC) workflow and report patient volume trends since its implementation in Jan 2015 at the University Of Iowa Hospitals & Clinics.Methods:We identified patients undergoing elective high blood loss (HBL) surgical procedures (defined as predicted blood loss >500 cc) with a preoperative hemoglobin (Hb) <12 g/dl as the target population for preoperative anemia management. We identified HBL procedures by ICD codes using information derived from our institutional maximum surgical blood-ordering schedule (MSBOS), intraoperative estimated blood loss (EBL) data from the electronic medical record (EMR) and surgical provider input. In calendar year 2014, 3262 elective HBL surgical patients were identified, out of which 452 (13.9%) received perioperative red cell transfusions. 232 (51.3%) of these patients had a preoperative Hb <12 g/dl. 61 (26%) of these patients were transfused 1 unit PRBCs, 62 (27%) were transfused 2 units and the remaining 109 (47%) patients were transfused > 2 units. Assuming 1- 2 unit transfusions were preventable by preoperative anemia managment, the calculated cost savings to the institution by avoiding these transfusions was estimated to be $200,000/year, not including potential improvement in length of stay. Using these data as baseline, a business plan for an AMC was presented to and approved by our hospital administration. An outpatient clinic was initiated in a temporaray location in early 2015 and later moved to a permanent location with infusion capabilities in August 2015 with two full time staff including a nurse practitioner and a medical assistant supervised by a nurse manager and a medical director. To streamline workflow, a stepwise algorithm for diagnosis and management of anemia was created by a multidisciplinary team that included Hematology, Anesthesiology, Surgery, Internal Medicine, Nursing and Pharmacy. We established referral mechanisms primarily from surgical clinics via automatic EMR alerts for elective HBL procedures linked to case scheduling through the EMR and secondarily through direct outpatient consultations.Results:We observed an overall trend of reduction in the percentage of patients transfused perioperatively in the two quarters following implementation of the preoperative AMC compared with the preceding quarterly intervals since Jan 2014 (Figure). In the same time period we observed a steady increase in number of patient visits to the AMC and number of iron infusions administered. Patient visits and iron infusions more than doubled in the first two quarters of 2016 compared to same time period in 2015 (594 vs 195 and 366 vs 124 respectively). There was a significant reduction in average length of stay (2.78 days) for patients who received transfusions after an AMC visit compared with patients who were not seen in the AMC.Conclusions:Implementation of a structured preoperative anemia management clinic (AMC) with an automatic referral workflow is feasible at a large academic medical center and appears to result in reductions in blood transfusions and hospital length of stay. The heterogeneity of our surgical population and the short timespan since implementation of the AMC are limitations of this analysis. We have ongoing efforts to minimize system errors in our referral mechanisms (ie appropriate EMR alerts to surgeons) and enhance surgical provider education to maximize preoperative anemia management opportunities. [Display omitted] DisclosuresNo relevant conflicts of interest to declare.

Contracting and Accountability Under Leaner Government

Federal government contracting has increased over the past three decades as a way to reduce costs and to promote greater efficiency and effectiveness in the procurement system. In making contracting decisions and calculating cost savings, however, officials do not always take into account all costs associated with the process. Transaction cost theory is used to analyze the costs incurred in contracting for gathering information, negotiation, and enforcement. Additionally, ethinomics is used to show that contracting can create circumstances that leave agencies open to unethical behavior with both monetary and social consequences. Despite documented improvement in resource allocation since 2009, many agencies still do not provide enough funding and adequate personnel to capture and reduce transaction costs in contract evaluation, monitoring, and performance outcome.

Enhanced cosyntropin stimulation test performance enabled by electronic medical record.

To improve performance of the cosyntropin stimulation test (CST) used for diagnosis of adrenal-cortisol insufficiency by implementing an electronic medical record (EMR) system protocol. We implemented a SmartForm protocol of the validated CST in our EMR system (CS-Link™, EPIC) system and compared medical staff test performance before and after protocol implementation. Correct performance of the CST improved significantly after EMR implementation. The number of correctly performed CSTs increased from 16.1% before to 53.5% after implementation (p<0.0001) while those performed incorrectly and were uninterpretable decreased from 36.2 to 7.1% (p<0.0001). This performance improvement result in a calculated cost savings of $50,414 for every 100 tests performed. The EMR system is useful for guiding medical staff to accurately perform the CST, reduce the number of wasted tests, and maximize staff time and resources.

Assessing the cost saving potential of shared product architectures

This article presents a method for calculating cost savings of shared architectures in industrial companies called Architecture Mapping and Evaluation. The main contribution is an operational method to evaluate the cost potential and evaluate the number of product architectures in an industrial company. Experiences from the case company show it is possible to reduce the number of architectures with 60% which leads to significant reduction in direct material and labor costs. This can be achieved without compromising the market offerings of products. Experiences from the case study indicate cost reductions between 0.5% and 2% of turnover. The main implication is that the method provides a quantitative basis for the discussion on whether or not to implement shared product architectures. This means a more fact-based approach is introduced.

Effectiveness of whole-exome sequencing and costs of the traditional diagnostic trajectory in children with intellectual disability.

This study investigated whole-exome sequencing (WES) yield in a subset of intellectually disabled patients referred to our clinical diagnostic center and calculated the total costs of these patients' diagnostic trajectory in order to evaluate early WES implementation. We compared 17 patients' trio-WES yield with the retrospective costs of diagnostic procedures by comprehensively examining patient records and collecting resource use information for each patient, beginning with patient admittance and concluding with WES initiation. We calculated cost savings using scenario analyses to evaluate the costs replaced by WES when used as a first diagnostic tool. WES resulted in diagnostically useful outcomes in 29.4% of patients. The entire traditional diagnostic trajectory average cost was $16,409 per patient, substantially higher than the $3,972 trio-WES cost. WES resulted in average cost savings of $3,547 for genetic and metabolic investigations in diagnosed patients and $1,727 for genetic investigations in undiagnosed patients. The increased causal variant detection yield by WES and the relatively high costs of the entire traditional diagnostic trajectory suggest that early implementation of WES is a relevant and cost-efficient option in patient diagnostics. This information is crucial for centers considering implementation of WES and serves as input for future value-based research into diagnostics.Genet Med 18 9, 949-956.

Impact of different sedation protocols and perioperative procedures on patients admitted to the intensive care unit after maxillofacial tumor surgery of the lower jaw: A retrospective study.

Maxillofacial tumor surgery often necessitates prolonged invasive ventilation to prevent blockage of the respiratory tract. To tolerate ventilation, continuously administered sedatives are recommended. Half-time of sedative or analgesic medication is an important characteristic by which narcotic drugs are chosen, due to the fact that weaning period increases with half-time. The aim of our study was to investigate whether a change in sedation regimen would affect the length of invasive ventilation or intensive care unit stay and medical costs. Additionally, the impact of various surgical procedures was analyzed. Data of 157 patients after mandibular surgery were retrospectively analyzed over 5 years in count regression models. Of those patients, 84 received a sedation regimen with sufentanil and midazolam and 73 with remifentanil and propofol. The impact of the surgical procedures (tracheostomy, tumor resection, neck dissection and length of operation) and the patient age and sex were analyzed with respect to length of ventilation and ICU days. Cost savings were calculated. Our data show that patients receiving remifentanil/propofol had fewer ventilation days (2.5±2.5 versus 6.1±4.6 days, P<0.001) and were discharged earlier from the intensive care unit than patients receiving sufentanil/midazolam (5.1±3.8 versus 9.2±6.2 days, P<0.001), leading to calculated cost savings of about 8000 Euro per patient. Length of operation negatively influenced length of ICU stay (P<0.001). In conclusion, short-acting drugs such as remifentanil/propofol, as well as tracheostoma and shortened surgery duration may reduce the postoperative need for invasive ventilation and length of intensive care unit stay.

A quality initiative of postoperative radiographic imaging performed on mastectomy specimens to reduce histology cost and pathology report turnaround time.

Breast pathology relies on gross dissection for accurate diagnostic work, but challenges can necessitate submission of high tissue volumes resulting in excess labor, laboratory costs, and delays. To address these issues, a quality initiative was created through implementation of the Faxitron PathVision specimen radiography system as part of the breast gross dissection protocol; this report documents its impact on workflow and clinical care. Retrospective data from 459 patients who underwent simple or modified radical mastectomy at our institution between May 2012 and December 2014 were collected. Comparison was made between the mastectomy specimen control group before radiography use (233 patients, 340 breasts) and Faxitron group that underwent postoperative radiography (226 patients, 338 breasts). We observed a statistically significant decrease in mean number of blocks between control and Faxitron groups (47.0 vs 39.7 blocks; P<.0001), for calculated cost savings of US $146 per mastectomy. A statistically significant decrease in pathology report turnaround time was also observed (4.2 vs 3.8days; P=.038). Postoperative mastectomy specimen radiography has increased workflow efficiency and decreased histology costs and pathology report turnaround time. These findings may underestimate actual benefits and highlight the importance of quality improvement projects in anatomical pathology.

Illustration of Cost Saving Implications of Lower Extremity Nerve Decompression to Prevent Recurrence of Diabetic Foot Ulceration.

The US diabetic foot ulcer (DFU) incidence is 3-4% of 22.3 million diagnosed diabetes cases plus 6.3 million undiagnosed, 858 000 cases total. Risk of recurrence after healing is 30% annually. Lower extremity multiple nerve decompression (ND) surgery reduces neuropathic DFU (nDFU) recurrence risk by >80%. Cost effectiveness of hypothetical ND implementation to minimize nDFU recurrence is compared to the current $6.171 billion annual nDFU expense. A literature review identified best estimates of annual incidence, recurrence risk, medical management expense, and noneconomic costs for DFU. Illustrative cost/benefit calculations were performed assuming widespread application of bilateral ND after wound healing to the nDFU problem, using Center for Medicare Services mean expense data of $1143/case for unilateral lower extremity ND. Calculations use conservative, evidence-based cost figures, which are contemporary (2012) or adjusted for inflation. Widespread adoption of ND after nDFU healing could reduce annual DFU occurrences by at least 21% in the third year and 24% by year 5, representing calculated cost savings of $1.296 billion (year 3) to $1.481 billion (year 5). This scenario proffers significant expense reduction and societal benefit, and represents a minimum 1.9× return on the investment cost for surgical treatment. Further large cost savings would require reductions in initial DFU incidence, which ND might achieve by selective application to advanced diabetic sensorimotor polyneuropathy (DSPN). By minimizing the contribution of recurrences to yearly nDFU incidence, ND has potential to reduce by nearly $1 billion the annual cost of DFU treatment in the United States.

Calculating cost savings in utilization management

A major motivation for managing the utilization of laboratory testing is to reduce the cost of medical care. For this reason it is important to understand the basic principles of cost accounting in the clinical laboratory. The process of laboratory testing includes three distinct components termed the pre-analytic, analytic and post-analytic phases. Utilization management efforts may impact the cost structure of these three phases in different ways depending on the specific details of the initiative. Estimates of cost savings resulting from utilization management programs reported in the literature have often been fundamentally flawed due to a failure to understand basic concepts such as the difference between laboratory costs versus charges and the impact of reducing laboratory test volumes on the average versus marginal cost structure in the laboratory. This article will provide an overview of basic cost accounting principles in the clinical laboratory including both job order and process cost accounting. Specific examples will be presented to illustrate these concepts in various different scenarios.

Observational Study and Estimate of Cost Savings from Use of a Health Information Exchange in an Academic Emergency Department

BackgroundFederal initiatives to improve health care information sharing have led to the development of a new type of regional electronic medical record known as a health information exchange (HIE). ObjectiveOur aim was to investigate the ability of an HIE to decrease health services use for emergency department (ED) patients. MethodsWe performed an observational, prospective study using a voluntary, anonymous survey among clinicians at an urban academic ED. All ED clinicians were eligible to participate. Survey items addressed clinician perception of whether information from the HIE avoided the use of hospital resources, improved quality of care, and reduced length of stay (LOS). Cost savings were estimated by multiplying the number of services the clinicians completing our survey reported they avoided through use of the HIE by the costs of those services at our facility. The study was approved by the Institutional Review Board at the study site. ResultsThe study was conducted between August and December of 2011. There were 18,529 patient encounters during the study period and 60 clinicians at the study site who were eligible to participate. The clinicians consulted the HIE for 5.39% of these encounters (998 patients). Surveys were completed by the clinicians caring for 13.8% (n = 138) of these patients. Of the completed surveys, 76% (105 surveys) referenced patients for whom the HIE was found to contain information on the patient under care by the clinician participant. These 105 patients formed the sample on which our analysis was based. Within this sample of patients, the following studies were reported to have been avoided by the clinicians participating in our survey: values are percent of patients for whom a study was reported to have been avoided (actual number of studies avoided): laboratory/microbiology: 30.5% (32 studies); radiologic studies: 47.6% (50 studies); consultations: 19% (20 consultations); and admissions: 11.4% (12 admissions). Calculated cost savings based on these estimates were as follows: laboratory/microbiology: $462.85; radiologic studies: $160,893.00; consultations: $3,990.00; and admissions: $118,131.84. Total savings: $283,477. Clinicians participating in the study reported improved quality of care for 86.7% of their patients, as well as a mean time savings of 120.8 minutes. ConclusionsAccording to clinician estimates, use of an HIE in this urban academic ED resulted in reduced use of hospital resources, noteworthy cost savings, decreased LOS, and improved quality of care. Limitations included the observational nature of the study, selection bias, the Hawthorne effect, and cost estimates being from a single institution. Allowance was not made for additional services used because of information obtained from the HIE.

Assisted reproductive technology: public funding and the voluntary shift to single embryo transfer in Australia

To calculate cost savings to the Australian federal and state governments from the reduction in twin and triplet birth rates for infants conceived by assisted reproductive technology (ART) since 2002, and to determine the number of ART treatment programs theoretically funded by means of these savings. Costing model using data from the Australia and New Zealand Assisted Reproduction Database, the National Perinatal Data Collection and Medicare Australia on ART treatment cycles undertaken in Australia between 2002 and 2008. Annual savings in maternal and infant inpatient birth-admission costs resulting from the reduction in ART multiple birth rate; theoretical number of ART treatment programs funded and infants born by means of these savings. The reduction in the ART multiple birth rate from 18.8% in 2002 to 8.6% in 2008 resulted in estimated savings to government of $47.6 million in birth-admission costs alone. Theoretically, these savings funded 7042 ART treatment programs comprising one fresh plus one frozen embryo transfer cycle, equating to the birth of 2841 babies. Fifty-five per cent of the increased use of ART services since 2002 has been theoretically funded by the reduction in multiple birth infants. Against a backdrop of supportive public funding of ART in Australia, a voluntary shift to single embryo transfer by fertility clinicians and ART patients has resulted in substantial savings in hospital costs. Much of the growth in ART use has been theoretically cross-subsidised by the move to safer embryo transfer practices.

Documenting clinical pharmacist intervention before and after the introduction of a web-based tool

To develop a database for documenting pharmacist intervention through a web-based application. The secondary endpoint was to determine if the new, web-based application provides any benefits with regards to documentation compliance by clinical pharmacists and ease of calculating cost savings compared with our previous method of documenting pharmacist interventions. A tertiary care hospital in Saudi Arabia. The documentation of interventions using a web-based documentation application was retrospectively compared with previous methods of documentation of clinical pharmacists' interventions (multi-user PC software). The number and types of interventions recorded by pharmacists, data mining of archived data, efficiency, cost savings, and the accuracy of the data generated. The number of documented clinical interventions increased from 4,926, using the multi-user PC software, to 6,840 for the web-based application. On average, we observed 653 interventions per clinical pharmacist using the web-based application, which showed an increase compared to an average of 493 interventions using the old multi-user PC software. However, using a paired Student's t-test there was no statistical significance difference between the two means (P = 0.201). Using a χ² test, which captured management level and the type of system used, we found a strong effect of management level (P < 2.2 × 10⁻¹⁶) on the number of documented interventions. We also found a moderately significant relationship between educational level and the number of interventions documented (P = 0.045). The mean ± SD time required to document an intervention using the web-based application was 66.55 ± 8.98 s. Using the web-based application, 29.06% of documented interventions resulted in cost-savings, while using the multi-user PC software only 4.75% of interventions did so. The majority of cost savings across both platforms resulted from the discontinuation of unnecessary drugs and a change in dosage regimen. Data collection using the web-based application was consistently more complete when compared to the multi-user PC software. The web-based application is an efficient system for documenting pharmacist interventions. Its flexibility and accessibility, as well as its detailed report functionality is a useful tool that will hopefully encourage other primary and secondary care facilities to adopt similar applications.

Ascensia® WinGLUCOFACTS® Professional Software Improves Diabetes Health Outcomes

Traditionally, people with diabetes keep handwritten blood glucose (BG) logs. Although a useful, and a necessary component of diabetes management, logbooks can be incomplete, inaccurate and illegible, which may lead to faulty analyses of BG trends associated with meals, medications and daily activities. Ascensia, WinGLUCOFACTS, Professional Software (WinGLUCOFACTS) from Bayer HealthCare was developed to assist in diabetes management by providing text and graphic presentations of downloaded data. It has a unique Data Wizard tool that automatically identifies BG trends. A one year outcome study was conducted at Baptist Primary Care (Jacksonville, Florida) to investigate whether use of WinGLUCOFACTS would improve BG control, diabetes related behaviors, and patient knowledge and attitudes. The cost effectiveness of this software in a primary care setting was also studied. Two physicians treated both the Test Group (90 subjects) and Control Group subjects (66 subjects). The Test Group subjects' diabetes was managed using WinGLUCOFACTS in conjunction with handwritten logs. The Control Group subjects' diabetes was managed using only handwritten logs. Both groups were scheduled to visit their physician 5 times, at 3 month intervals over the course of the 12 month study. Hemoglobin A1C (A1C) dropped by about half a percentage point from baseline for both Control Group (-0.48) and Test Group subjects (-0.58) at the 3 month visit, a clinically significant change. The Control Group's A1C levels, however, increased at each succeeding visit, so that at 9 and 12 months it was statistically indistinguishable from baseline, whereas the Test Group's A1C remained significantly lower than baseline (-0.64 and -0.41; 90% confidence level). Based on published methodologies for calculating cost savings related to such a sustained reduction in A1C, annual cost savings would be $75.04 to $111.54 per patient or $75,040 to $111,540 per 1000 patients. The use of WinGLUCOFACTS also had a positive effect on patients' diabetes related behaviors and on their satisfaction with their care. A majority of Test Group subjects wanted their physician to continue using WinGLUCOFACTS. The physicians expressed satisfaction with this data management system, stating that it helped them to manage the Test Group subjects' diabetes by analyzing BG trends. The use of Ascensia WinGLUCOFACTS Professional Software from Bayer HealthCare helped in the management of patients' diabetes. It improved overall glycemic control, increased their knowledge of diabetes, increased SMBG frequency, and their satisfaction with care, and was cost effective. The primary care physicians confirmed the benefit afforded by this software in the real-world management of diabetes.

Non-invasive home mechanical ventilation: Effectiveness and efficiency of an outpatient initiation protocol compared with the standard in-hospital model

To compare the effectiveness and efficiency of an initiation protocol for non-invasive home mechanical ventilation (NIHMV) carried out at a pulmonary outpatient clinic with the standard in-hospital model. Prospective, observational study. 16 patients divided into two groups: (A) outpatient protocol (n=9); and (B) standard in-hospital initiation with an elective admission (n=7). at baseline condition and treatment starting, arterial blood gases and nocturnal pulse-oximetry were performed. At the end of follow-up, arterial blood gases and patient compliance (ventilator's built-in counter) was determined. Efficiency was evaluated by calculating cost savings per ventilated patient for the financier and accumulated days of hospitalization saved. No differences in baseline conditions were observed. Ventilation was effective in the two groups: a significant decrease in PaCO(2) and an increase in mean nocturnal oxygen saturation were observed after initiating ventilation. (Group A: PaCO(2):42.9+/-1.5; SpO(2):91.9+/-1.9; Group B:PaCO(2):44.3+/-6; SpO(2):91.9+/-2.7). At three months the effectiveness of ventilation and the number of hours of ventilation was equivalent in all groups. The new model cut costs for the health care financier by 50%. The outpatient sessions saved 63 days of hospitalization. (1) Outpatient initiation is an effective and efficient alternative to the traditional in-hospital method for NIHMV. (2) The outpatient protocol represents a substantial saving for the financier.

Reduction in catheter-associated urinary tract infection (CAUTI) using a silver-coated all-silicone Foley catheter versus a silver-impregnated latex Foley catheter in a Southeastern U.S. long-term acute care facility

BACKGROUND: Infection control surveillance for nosocomial catheter-associated urinary tract infection (CAUTI) is often performed in intensive care units (ICUs) where comparison to NNIS data is possible. There is much information regarding CAUTI incidence in large teaching facilities. However, there are few benchmarks for use in small specialty facilities. This facility is a 49 bed long-term acute care (LTAC) hospital located in the Southeastern United States. Average LOS (length of stay) is >25 days. The LTAC serves a geographic radius of approximately 100 miles. OBJECTIVES: Compare the facility's existing CAUTI rate using a silver-impregnated latex Foley catheter to the CAUTI rate using a silver-coated all-silicone catheter. Quantify the economic and patient safety impact on this hospital. METHODS: Total facility surveillance of nosocomial CAUTIs was completed using Centers for Disease Control and Prevention (CDC) definitions. A comprehensive concurrent chart review was conducted for all patients with Foley catheters who presented with positive urine cultures >48 hours after admission. The baseline period utilizing the silver latex catheter was March–December 2003. These months were then compared to the same months utilizing the all-silicone silver-coated Foley in the subsequent year. RESULTS: The novel silver-coated all-silicone Foley catheter had 17% fewer CAUTIs in the time period studied. Compliance with hand hygiene and Foley catheter care was similar during the two timeframes. The calculated cost savings in the trial period was $49,439. CONCLUSIONS: Use of a novel silver-coated all-silicone Foley catheter resulted in major reductions in the incidence of CAUTI and cost. Switching to all-silicone silver-coated urinary catheters in the LTAC setting could substantially decrease nosocomial CAUTI, thereby improving patient safety. Further investigation is recommended. BACKGROUND: Infection control surveillance for nosocomial catheter-associated urinary tract infection (CAUTI) is often performed in intensive care units (ICUs) where comparison to NNIS data is possible. There is much information regarding CAUTI incidence in large teaching facilities. However, there are few benchmarks for use in small specialty facilities. This facility is a 49 bed long-term acute care (LTAC) hospital located in the Southeastern United States. Average LOS (length of stay) is >25 days. The LTAC serves a geographic radius of approximately 100 miles. OBJECTIVES: Compare the facility's existing CAUTI rate using a silver-impregnated latex Foley catheter to the CAUTI rate using a silver-coated all-silicone catheter. Quantify the economic and patient safety impact on this hospital. METHODS: Total facility surveillance of nosocomial CAUTIs was completed using Centers for Disease Control and Prevention (CDC) definitions. A comprehensive concurrent chart review was conducted for all patients with Foley catheters who presented with positive urine cultures >48 hours after admission. The baseline period utilizing the silver latex catheter was March–December 2003. These months were then compared to the same months utilizing the all-silicone silver-coated Foley in the subsequent year. RESULTS: The novel silver-coated all-silicone Foley catheter had 17% fewer CAUTIs in the time period studied. Compliance with hand hygiene and Foley catheter care was similar during the two timeframes. The calculated cost savings in the trial period was $49,439. CONCLUSIONS: Use of a novel silver-coated all-silicone Foley catheter resulted in major reductions in the incidence of CAUTI and cost. Switching to all-silicone silver-coated urinary catheters in the LTAC setting could substantially decrease nosocomial CAUTI, thereby improving patient safety. Further investigation is recommended.