Critical care clinics
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Critical care clinics · Jan 2012
ReviewEconomic aspects of preventing health care-associated infections in the intensive care unit.
Infection prevention is critical to providing a high standard of care in the intensive care unit (ICU). Recent focus on eliminating health care–associated infections (HAIs) has met with variable results. Although evidence-based as far as their components, policy-driven bundled HAI prevention interventions have been evaluated in a limited and potentially biased fashion for their effectiveness, and analyses of their cost-effectiveness are lacking. We use ventilator-associated pneumonia as the case study to illustrate the pitfalls and challenges of arriving at the optimal HAI preventive strategies in the ICU.
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The intensive care unit (ICU) is a complex system and the economic implications of altering care patterns in the ICU can be difficult to unravel. Few studies have specifically examined the economics of implementing organizational and management changes or acknowledged the many competing economic interests of patient, hospital,payer, and society. With continuously increasing healthcare costs,there is a great need for more studies focused on the optimal organization of the ICU. These studies should not focus solely on reductions in ICU length of stay but should strive to measure the true costs of care within a given healthcare system.
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The main drivers of critical care medicine (CCM) costs are the numbers and use of intensive care unit (ICU) beds. The Russell equation, an indirect costing methodology, is most commonly used to estimate national CCM costs. Calculating national CCM costs in a standardized manner remains challenging because there is no universal approach to defining the types of hospitals, ICU beds, days, and billing codes to be included in the overall cost. Although numerous CCM cost-containment strategies have been proposed or implemented, CCM cost reduction remains elusive, and measuring cost remains challenging,given the complexities involved in assessing costs.
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Critical care clinics · Jan 2012
ReviewEconomic and outcomes aspects of venous thromboembolic disease.
Critically ill patients clearly face an increased risk for developing venous thromboembolic disease (VTE). Upon admission, all critical care patients should be immediately assessed for and prescribed VTE prophylaxis as it can significantly reduce VTE occurrence, its potential sequelae,and costs associated with VTE treatment. ⋯ Longer ICU and hospital lengths of stay, pharmacy costs, and further outpatient management all contribute considerably to the economic burden of disease. The importance of this healthcare issue should motivate hospital administrators and physicians to systematically initiate thromboprophylaxis in all ICU patients.
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Sepsis, severe sepsis, and septic shock impose a growing economic burden on health care systems globally. This article first describes the epidemiology of sepsis within the United States and internationally. It then reviews costs associated with sepsis and its management in the United States and internationally, including general cost sources in intensive care, direct costs of sepsis, and indirect costs of the burden of illness imposed by sepsis. Finally, it examines the cost-effectiveness of sepsis interventions, focusing on formal cost-effectiveness analyses of nosocomial sepsis prevention strategies, drotrecogin alfa (activated),and integrated sepsis protocols.