Abstract
Our goals: (a) to design value strategies for optimal diagnosis and treatment of sepsis; (b) to assess theoretical marginal penalties of inadequate antimicrobial treatment of intensive care patients with infections (case study) ; and (c) to analyse physician antibiotic alterations in patients with blood culture-proven bloodstream infections. Marginal penalties, which reflect extra procedures and excess costs arising from uninformed treatment decisions, were transformed to subject group-distributed opportunity costs. Value analysis revealed substantial marginal penalties associated with adverse factors, such as increased ICU length of stay, procedures (catheterisation, mechanical ventilation, tracheostomy) and ultimately, higher mortality, in critically ill patients. Investigation of 66 septicaemica patients (International Classification of Disease [ICD-9] code 038 and related derivatives) hospitalised over 17 months revealed that physicians altered antibiotics extensively during three time intervals: TI1 - collection of blood for culture to qualitative positive blood culture notification, TI2 - notification to final MIC result, and TI3 - final MIC result to 72 hours afterward. Empirical antibiotic alterations during TI1 may have adversely affected survival. Alterations peaked after blood collection and after notification of qualitative positive blood culture results. Based on patterns of alterations and 28-day mortality, we hypothesize that nucleic acid testing, if used to identify organisms and rule in bloodstream infections early (4-6 h) following admission, will help facilitate diagnosis, focus antibiotic therapy, and avert dysfunctional sepsis cascades. Reduced "alteration debt" and marginal penalties should offset the costs of nucleic acid testing. The potential for enhanced survival and improved outcomes warrants clinical trials of rapid nucleic acid testing to decrease indiscriminate antibiotic alterations, evaluate proposed value strategies, and test outcome hypotheses.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 16-26 |
| Number of pages | 11 |
| Journal | Scandinavian Journal of Clinical and Laboratory Investigation, Supplement |
| Volume | 63 |
| Issue number | 239 |
| State | Published - 2003 |
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Keywords
- Alteration debt
- Cost effectiveness
- Frame shift
- Length of stay (LOS)
- Multiple organ dysfunction syndrome (MODS)
- Nucleic acid testing
- Pathogen
- Systemic inflammatory response syndrome (SIRS)
- Value analysis
- Value proposition
- Value strategy
ASJC Scopus subject areas
- Clinical Biochemistry
Cite this
Economic implications of optimal diagnosis and treatment of sepsis - Work in progress : Marginal penalties, antibiotic alterations, and outcome hypotheses. / Kost, Gerald J; Tang, Zuping; Tran, Nam; Curd, Emily E.; Louie, Richard F.; Albertson, Timothy E; Derlet, Robert W.; Azari, Rahman.
In: Scandinavian Journal of Clinical and Laboratory Investigation, Supplement, Vol. 63, No. 239, 2003, p. 16-26.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Economic implications of optimal diagnosis and treatment of sepsis - Work in progress
T2 - Marginal penalties, antibiotic alterations, and outcome hypotheses
AU - Kost, Gerald J
AU - Tang, Zuping
AU - Tran, Nam
AU - Curd, Emily E.
AU - Louie, Richard F.
AU - Albertson, Timothy E
AU - Derlet, Robert W.
AU - Azari, Rahman
PY - 2003
Y1 - 2003
N2 - Our goals: (a) to design value strategies for optimal diagnosis and treatment of sepsis; (b) to assess theoretical marginal penalties of inadequate antimicrobial treatment of intensive care patients with infections (case study) ; and (c) to analyse physician antibiotic alterations in patients with blood culture-proven bloodstream infections. Marginal penalties, which reflect extra procedures and excess costs arising from uninformed treatment decisions, were transformed to subject group-distributed opportunity costs. Value analysis revealed substantial marginal penalties associated with adverse factors, such as increased ICU length of stay, procedures (catheterisation, mechanical ventilation, tracheostomy) and ultimately, higher mortality, in critically ill patients. Investigation of 66 septicaemica patients (International Classification of Disease [ICD-9] code 038 and related derivatives) hospitalised over 17 months revealed that physicians altered antibiotics extensively during three time intervals: TI1 - collection of blood for culture to qualitative positive blood culture notification, TI2 - notification to final MIC result, and TI3 - final MIC result to 72 hours afterward. Empirical antibiotic alterations during TI1 may have adversely affected survival. Alterations peaked after blood collection and after notification of qualitative positive blood culture results. Based on patterns of alterations and 28-day mortality, we hypothesize that nucleic acid testing, if used to identify organisms and rule in bloodstream infections early (4-6 h) following admission, will help facilitate diagnosis, focus antibiotic therapy, and avert dysfunctional sepsis cascades. Reduced "alteration debt" and marginal penalties should offset the costs of nucleic acid testing. The potential for enhanced survival and improved outcomes warrants clinical trials of rapid nucleic acid testing to decrease indiscriminate antibiotic alterations, evaluate proposed value strategies, and test outcome hypotheses.
AB - Our goals: (a) to design value strategies for optimal diagnosis and treatment of sepsis; (b) to assess theoretical marginal penalties of inadequate antimicrobial treatment of intensive care patients with infections (case study) ; and (c) to analyse physician antibiotic alterations in patients with blood culture-proven bloodstream infections. Marginal penalties, which reflect extra procedures and excess costs arising from uninformed treatment decisions, were transformed to subject group-distributed opportunity costs. Value analysis revealed substantial marginal penalties associated with adverse factors, such as increased ICU length of stay, procedures (catheterisation, mechanical ventilation, tracheostomy) and ultimately, higher mortality, in critically ill patients. Investigation of 66 septicaemica patients (International Classification of Disease [ICD-9] code 038 and related derivatives) hospitalised over 17 months revealed that physicians altered antibiotics extensively during three time intervals: TI1 - collection of blood for culture to qualitative positive blood culture notification, TI2 - notification to final MIC result, and TI3 - final MIC result to 72 hours afterward. Empirical antibiotic alterations during TI1 may have adversely affected survival. Alterations peaked after blood collection and after notification of qualitative positive blood culture results. Based on patterns of alterations and 28-day mortality, we hypothesize that nucleic acid testing, if used to identify organisms and rule in bloodstream infections early (4-6 h) following admission, will help facilitate diagnosis, focus antibiotic therapy, and avert dysfunctional sepsis cascades. Reduced "alteration debt" and marginal penalties should offset the costs of nucleic acid testing. The potential for enhanced survival and improved outcomes warrants clinical trials of rapid nucleic acid testing to decrease indiscriminate antibiotic alterations, evaluate proposed value strategies, and test outcome hypotheses.
KW - Alteration debt
KW - Cost effectiveness
KW - Frame shift
KW - Length of stay (LOS)
KW - Multiple organ dysfunction syndrome (MODS)
KW - Nucleic acid testing
KW - Pathogen
KW - Systemic inflammatory response syndrome (SIRS)
KW - Value analysis
KW - Value proposition
KW - Value strategy
UR - http://www.scopus.com/inward/record.url?scp=0043234608&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=0043234608&partnerID=8YFLogxK
M3 - Article
AN - SCOPUS:0043234608
VL - 63
SP - 16
EP - 26
JO - Scandinavian Journal of Clinical and Laboratory Investigation, Supplement
JF - Scandinavian Journal of Clinical and Laboratory Investigation, Supplement
SN - 0085-591X
IS - 239
ER -