@article {Padula132, author = {William V Padula and Peter J Pronovost and Mary Beth F Makic and Heidi L Wald and Dane Moran and Manish K Mishra and David O Meltzer}, title = {Value of hospital resources for effective pressure injury prevention: a cost-effectiveness analysis}, volume = {28}, number = {2}, pages = {132--141}, year = {2019}, doi = {10.1136/bmjqs-2017-007505}, publisher = {BMJ Publishing Group Ltd}, abstract = {Objective Hospital-acquired pressure injuries are localised skin injuries that cause significant mortality and are costly. Nursing best practices prevent pressure injuries, including time-consuming, complex tasks that lack payment incentives. The Braden Scale is an evidence-based stratification tool nurses use daily to assess pressure-injury risk. Our objective was to analyse the cost-utility of performing repeated risk-assessment for pressure-injury prevention in all patients or high-risk groups.Design Cost-utility analysis using Markov modelling from US societal and healthcare sector perspectives within a 1-year time horizon.Setting Patient-level longitudinal data on 34 787 encounters from an academic hospital electronic health record (EHR) between 2011 and 2014, including daily Braden scores. Supervised machine learning simulated age-adjusted transition probabilities between risk levels and pressure injuries.Participants Hospitalised adults with Braden scores classified into five risk levels: very high risk (6{\textendash}9), high risk (10{\textendash}11), moderate risk (12{\textendash}14), at-risk (15{\textendash}18), minimal risk (19{\textendash}23).Interventions Standard care, repeated risk assessment in all risk levels or only repeated risk assessment in high-risk strata based on machine-learning simulations.Main outcome measures Costs (2016 $US) of pressure-injury treatment and prevention, and quality-adjusted life years (QALYs) related to pressure injuries were weighted by transition probabilities to calculate the incremental cost-effectiveness ratio (ICER) at $100 000/QALY willingness-to-pay. Univariate and probabilistic sensitivity analyses tested model uncertainty.Results Simulating prevention for all patients yielded greater QALYs at higher cost from societal and healthcare sector perspectives, equating to ICERs of $2000/QALY and $2142/QALY, respectively. Risk-stratified follow-up in patients with Braden scores \<15 dominated standard care. Prevention for all patients was cost-effective in \>99\% of probabilistic simulations.Conclusion Our analysis using EHR data maintains that pressure-injury prevention for all inpatients is cost-effective. Hospitals should invest in nursing compliance with international prevention guidelines.}, issn = {2044-5415}, URL = {https://qualitysafety.bmj.com/content/28/2/132}, eprint = {https://qualitysafety.bmj.com/content/28/2/132.full.pdf}, journal = {BMJ Quality \& Safety} }