高风险科室手卫生依从性电子监测与人工监测方法的卫生经济学效益

Health economic benefits of electronic system-based monitoring and manual paper-based monitoring in hand hygiene compliance in high-risk departments

目的比较手卫生依从性电子监测(electronic system-based monitoring,ESM)与人工监测(manual paper-based monitoring,MPM)的经济学效益,为临床高风险科室手卫生监测方法提供参考。方法收集某大型三级甲等医院的呼吸与危重症医学科、创伤与显微骨科、儿科重症监护室、感染科、关节与运动医学科、呼吸与危重症医学科普通病区、神经内科、神经外科、食管纵膈与淋巴肿瘤放化疗科、头颈与儿童肿瘤放化疗科、血液内科11个高风险科室,2022年12月—2023年5月ESM和MPM两种手卫生监测方法实施期间的成本投入和效果产出,应用TreeAge Pro 2022软件构建决策树模型,测算成本效果、成本效率、霍桑效应和间接成本效益。结果ESM方法的总成本(4868.55元)低于MPM方法(7122.12元),但ESM方法的手卫生依从率(61.33%)低于MPM方法(78.79%)。MPM方法的成本效果比(9039.37元)高于ESM方法(7938.28元),增量成本效果比为17.46%。MPM方法的成本效率比(72013.35元)明显高于ESM方法(8813.45元)。MPM方法的霍桑效应(59.45%)高于ESM方法(47.90%)。MPM方法的成本效益比(2894.70元)低于ESM方法的成本效益比(4765.98元)。当支付意愿低于18500元时,ESM方法是更具成本效果的选择;当投入高于该阈值时,MPM方法是更具成本效果的选择。结论对于感染控制高风险科室,ESM方法的成本效果、成本效率、成本效益均优于MPM方法,但两者霍桑效应的差异无统计学意义。

Objective To compare the economic benefits of electronic system-based monitoring(ESM)and manual paper-based monitoring(MPM)in hand hygiene(HH)compliance,and provide reference for HH monitoring methods in high-risk clinical departments.Methods Eleven high-risk departments,including pulmonary and critical care medicine,department of trauma and micro-orthopedics,pediatric intensive care unit,department of infectious diseases,department of joint and sports medicine,general ward of pulmonary and critical care medicine,department of neurology,department of neurosurgery,department of radiochemotherapy for esophageal and mediastinal tumor lymphoma,department of radiochemotherapy for head,neck and children’s tumor,and department of hematology in a large tertiary first-class hospital were analyzed.A decision tree model was constructed using TreeAge Pro 2022 software to calculate cost-effectiveness,cost-efficiency,Hawthorne effect,and indirect cost-benefit of the cost input and effect output during the implementation period of the two monitoring methods from December 2022 to May 2023.Results The total cost of the ESM method was lower than that of the MPM method(4868.55 Yuan vs 7122.12 Yuan),but HH compliance rate of the ESM method was lower than that of the MPM method(61.33%vs 78.79%).The cost-effectiveness ratio of MPM method was higher than that of ESM method(9039.37 Yuan vs 7938.28 Yuan),with an incremental cost-effectiveness ratio of 17.46%.The cost-efficiency ratio of MPM method was significantly higher than that of ESM method(72013.35 Yuan vs 8813.45 Yuan).The Hawthorne effect of MPM method was higher than that of ESM method(59.45%vs 47.90%).The cost-benefit ratio of MPM method was lower than that of ESM method(2894.70 Yuan vs 4765.98 Yuan).When the payment willingness was less than 18500 Yuan,the ESM method was the better option for cost-effectiveness;When the input exceeded this threshold,the MPM method was the better option for cost-effectiveness.Conclusion For high-risk infection control departments,the ESM method is superior to MPM in cost-effectiveness,cost-efficiency and cost-benefit,but there is no statistically significant difference in the Hawthorne effect between the two methods.