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Observational Study
. 2024 Aug 15;19(8):e0308948.
doi: 10.1371/journal.pone.0308948. eCollection 2024.

The impact of adhering to a quality indicator for sedation, analgesia, and delirium management on costs, revenues, and clinical outcomes in intensive care in Germany: A retrospective observational study

Alexander Zuber  1   2 , Kerstin Rubarth  3 , Frank Förster  4 , Felix Balzer  2 , Claudia Spies  5 , Daniel Fürstenau  2   6 , Oliver Kumpf  5
Affiliations
Observational Study

The impact of adhering to a quality indicator for sedation, analgesia, and delirium management on costs, revenues, and clinical outcomes in intensive care in Germany: A retrospective observational study

Alexander Zuber et al. PLoS One. .

Abstract

Background: Management of sedation, analgesia, and delirium influences morbidity, mortality, and quality of life in patients treated in intensive care. Assessing quality indicators as part of a quality management and assurance program is an established method to ensure process quality. Currently, there is limited research on the effect of evaluating quality indicators on economic outcomes. The aim of the study was to investigate the adherence to an indicator on management of sedation, analgesia and delirium, and explore potential effects on hospital economics and clinical outcomes.

Methods: In this retrospective cohort study, we analyzed routine data from 20,220 patient records from the hospital information system of a tertiary university hospital, collected from January 2012 to December 2019. We compared two predefined subgroups with either high indicator adherence or low indicator adherence regarding factors like disease severity scores, comorbidities, and outcome measures. We used logistic regression models to examine the influence of quality indicator adherence on economic measures such as Diagnosis-related group (DRG) incomes, revenue margins, and costs, and clinical outcomes. Additionally, we used propensity score matching to probe our findings.

Results: Overall revenue margins in this cohort were negative (-320€). High adherence to the quality indicator was associated with a positive revenue margin (+197€) compared to low adherence (-482€). Higher adherence was also associated with lower costs. Additionally, high adherence was associated with reduced mortality (OR 0.84, 95% CI 0.75-0.95) and reduced duration of mechanical ventilation and hospital stay (17 hours and 1 day respectively).

Conclusion: Higher adherence to a quality indicator for sedation, analgesia, and delirium management was associated with economic returns and costs. We also found an association with lower mortality and reduced length of stay. Further research on these associations may help identify opportunities for quality improvement without increased resource use.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. CONSORT diagram of the study.
See this image and copyright information in PMC

References

    1. Kumpf O. [Quality indicators in intensive care medicine: Background and practical use]. Med Klin Intensivmed Notfmed. 2021;116(1):17–28. Epub 2019/12/12. doi: 10.1007/s00063-019-00630-w . - DOI - PubMed
    1. Kumpf O, Nothacker M, Braun J, Muhl E. The future development of intensive care quality indicators—a methods paper. German medical science: GMS e-journal. 2020;18:Doc09. Epub 2020/11/21. doi: 10.3205/000285 ; PubMed Central PMCID: PMC7656810. - DOI - PMC - PubMed
    1. Flaatten H. National ICU Quality Indicators Revisited. ICU Managment & Practice. 2016;(4):202–4.
    1. Kumpf O, Braun JP, Brinkmann A, Bause H, Bellgardt M, Bloos F, et al.. Quality indicators in intensive care medicine for Germany—third edition 2017. German medical science: GMS e-journal. 2017;15:Doc10. Epub 2017/08/11. doi: 10.3205/000251 ; PubMed Central PMCID: PMC5541336. - DOI - PMC - PubMed
    1. Hermes C, Ottens T, Knitter P, Hauss O, Bellgardt M, von Dossow V. [Delirium-assessment, prevention and treatment: Task in the interprofessional intensive care unit team]. Med Klin Intensivmed Notfmed. 2022;117(6):479–88. Epub 2022/07/30. doi: 10.1007/s00063-022-00943-3 . - DOI - PubMed

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