Prevention of Nosocomial Infections and Cost-Effectiveness Analysis

描述(由申请人提供)：医疗保健相关感染(HAI)是发病率和死亡率的主要来源，尽管它们通常是可以预防的。大多数HAI与侵入性设备有关，并不成比例地发生在重症监护病房(ICU)的老年患者中。据估计，HAI每年给医院造成的成本为65亿美元。虽然HAI的影响可能远远超出出院，特别是在老年人中，但很少有关于HAI对长期健康或经济后果的研究。30多年前，美国疾病控制和预防中心(CDC)利用调查和病历审查进行了一项开创性的全国性研究，其中感染控制人员的水平和感染预防、监测和控制(IPSC)干预的强度与HAI率有关。然而，这项研究尚未更新。虽然目前有一些指导方针，但建议并不一致，也没有得到很好的遵守。尽管HAI率不断上升，需要评估当前IPSC过程的影响，但对其临床有效性和成本效益的了解仍存在差距。其目的是：1)描述目前全国ICU中感染控制人员的水平和IPSC干预措施的强度；2)确定当前感染控制人员和IPSC干预措施强度之间的关系，以及HAI和老年ICU患者短期生存的概率；3)估计老年患者HAI的长期结果；以及4)确定ICU中有效的感染控制人员和IPSC干预措施的成本效益。我们修订了疾控中心研究中使用的调查，以反映当前的IPSC流程(即人员配置和IPSC的十项干预措施)。新的调查经过试点测试，发现是可靠和有效的。为了达到目标1，我们建议在数据收集的第一阶段对参与疾控中心国家医疗安全网络(NHSN)的感染控制专业人员样本进行调查，以确定当前的IPSC流程。为了达到目标2，在数据收集的第二阶段，我们将从第一阶段的受访者中随机抽取一个分层的亚样本，获得标准化的HAI数据、83个ICU的管理数据和老年患者的医疗保险档案(n~8万)。对于目标3，我们将在先前研究(R01HS11978)的基础上，使用NHSN方案跟踪确诊为HAI和非HAI的老年患者(n=39,314)。我们将使用5年的医疗保险数据跟踪这一队列。所有数据将用于目标4。建议的分析战略包括旨在最大限度地减少潜在偏见和解决数据聚集问题的多变量计量经济学方法。结果将为感染控制专业人员和床边临床医生的实践提供信息，使他们能够根据现有证据开展实践，这将改善患者结局并降低HAI率。

DESCRIPTION (provided by applicant): Healthcare associated infections (HAI) are a major source of morbidity and mortality despite the fact that they are often preventable. Most HAI are associated with an invasive device and disproportionately occur in elderly patients admitted to intensive care units (ICU). The annual cost of HAI to hospitals has been estimated to be $6.5 billion. While effects of HAI are likely to extend well beyond hospital discharge, especially in the elderly, there has been little study of the long term health or economic outcomes attributable to HAI. Over 30 years ago, using a survey and medical record reviews, the Centers for Disease Control and Prevention (CDC) conducted a seminal national study in which level of infection control staffing and intensity of infection prevention, surveillance, and control (IPSC) interventions were linked to HAI rates. However, this study has not been updated. While a number of current guidelines exist, recommendations are inconsistent and poorly followed. Despite rising HAI rates and the need to assess the impact of current IPSC processes, there is a gap in the knowledge regarding both their clinical effectiveness and cost-effectiveness. The aims are to: 1) Describe the level of infection control staffing and intensity of IPSC interventions currently in place in ICU across the nation; 2) Determine associations between current infection control staffing and intensity of IPSC interventions, and probability HAI and short term survival in elderly ICU patients; 3) Estimate the long term outcomes attributable to HAI in elderly patients; and 4) Determine the cost-effectiveness of effective infection control staffing and IPSC interventions in ICU. We have revised the survey used in the CDC study to reflect current IPSC processes (i.e., staffing and ten IPSC interventions). The new survey was pilot tested and found to be reliable and valid. To meet Aim 1, we propose to use this survey during Phase I of data collection in a sample of infection control professionals who participate in the CDC's National Healthcare Safety Network (NHSN) to determine current IPSC processes. To meet Aim 2, in Phase II of data collection, we will randomly select a stratified sub-sample from Phase I respondents and obtain standardized HAI data, administrative data in 83 ICU, and Medicare files for elderly patients (n ~ 80,000). For Aim 3, we will build upon a previous study (R01HS11978) and follow a cohort of elderly patients (n = 39,314) identified with and without HAI using the NHSN protocols. We will follow this cohort using 5-years of Medicare data. All data will be used for Aim 4. The analytic strategies proposed include multivariate econometric methods designed to minimize potential bias and address clustering of data. Results will inform the practice of infection control professionals and bedside clinicians, allowing them to base their practices on current evidence, which should improve patient outcomes and reduce HAI rates.