ArticleCritical care medicine2016
Using Incentives to Improve Resource Utilization: A Quasi-Experimental Evaluation of an ICU Quality Improvement Program.
Article in Critical care medicine, 2016. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 11 papers, 3 of them syntheses that pooled it.
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Who cites it
11 citing papers in PubMed, 3 syntheses or guidelines pooled it, 29 citations in OpenAlex.
- How well do critical care audit and feedback interventions adhere to best practice? Development and application of the REFLECT-52 evaluation tool.Implementation science : IS · 2021Pooled it
- Audit and feedback to improve laboratory test and transfusion ordering in critical care: a systematic review.Implementation science : IS · 2020Pooled it
- Behaviour modification interventions to optimise red blood cell transfusion practices: a systematic review and meta-analysis.BMJ open · 2018Pooled it
- Interventions to reduce low-value care in intensive care settings: a scoping review of impacts on health, resource use, costs, and the environment.Intensive care medicine · 2024Article
- Less is more for greener intensive care.Intensive care medicine · 2024Article
- Supporting efficiency improvement in public health systems: a rapid evidence synthesis.BMC health services research · 2022Review
- Driving Efficiency Improvement (EI): Exploratory Analysis of a Centralised Model in New South Wales.Risk management and healthcare policy · 2022Article
- Implementation of theJournal of comparative effectiveness research · 2021Article
- Routine intensive monitoring but not routine intensive care unit-based management is necessary in video-assisted thoracoscopic surgery lobectomy for lung cancer.Annals of translational medicine · 2019Article
- Modes of mechanical ventilation vary between hospitals and intensive care units within a university healthcare system: a retrospective observational study.BMC research notes · 2018Observational
- Changing Intensivists' Behaviors: A Challenge in Need of New Solutions.American journal of respiratory and critical care medicine · 2017Article
Corrections and comments
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Authors and funding
9 authors at 1 institution in 1 country.
Funding
Abstract
objectivesHealthcare systems strive to provide quality care at lower cost. Arterial blood gas testing, chest radiographs, and RBC transfusions provide an important example of opportunities to reduce excess resource utilization within the ICU. We describe the effect of a multifaceted quality improvement program designed to decrease the avoidable arterial blood gases, chest radiographs, and RBC utilization on utilization of these resources and patient outcomes.
designProspective pre-post cohort study.
settingSeven ICUs in an academic healthcare system. PATIENTS: All adult ICU patients admitted to study ICUs during consecutive baseline (n = 7,357), intervention (n = 7,553), and follow-up (n = 7,657) years between September 2010 and August 2013.
interventionsA multifaceted quality improvement program including provider education, audit and feedback, and unit-based provider financial incentives targeting arterial blood gas, chest radiograph, and RBC utilization. MEASUREMENTS AND MAIN
resultsThe primary outcome was the number of orders for arterial blood gases, chest radiographs, and RBCs per patient. Compared with the baseline period, unadjusted arterial blood gas, chest radiograph, and RBC utilization in the intervention period was reduced by 42%, 26%, and 17%, respectively (p < 0.01). After adjusting for potentially relevant patient factors, the intervention was associated with 128 fewer arterial blood gases, 73 fewer chest radiographs, and 16 fewer RBCs per 100 patients (p < 0.01). This effect was durable during the follow-up year. This reduction yielded an approximate net savings of $1.5 M in direct costs over the intervention and follow-up years after accounting for the direct costs of the program. Unadjusted hospital mortality decreased from 7% in the baseline period to 5.2% in the intervention period (p < 0.01). This reduction remained significant after adjusting for patient factors (odds ratio = 0.43; p < 0.01).
conclusionsImplementation of a multifaceted quality improvement program including financial incentives was associated with significant improvements in resource utilization. Our findings provide evidence supporting the safety, effectiveness, and sustainability of incentive-based quality improvement interventions.
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