Effect of Evidence-Based Acute Pain Management Practices on Inpatient Costs

Authors

  • John M. Brooks,

    1. Program in Pharmaceutical Socioeconomics, College of Pharmacy, University of Iowa, S-515 PB, 115 S. Grand Avenue, Iowa City, IA 52242,
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    • Address correspondence to John M. Brooks, Ph.D., Associate Professor, Program in Pharmaceutical Socioeconomics, College of Pharmacy, University of Iowa, S-515 PB, 115 S. Grand Avenue, Iowa City, IA 52242; e-mail: john-brooks@uiowa.edu. Marita G. Titler, Ph.D., R.N., F.A.A.N., Senior Assistant Director, is with the University of Iowa Hospitals and Clinics, Iowa City, IA, and as Director with the Research, Quality and Outcomes Management, Department of Nursing Services and Patient Care, University of Iowa Hospitals and Clinics, Iowa City, IA. Gail Ardery, Ph.D., R.N., Senior Research Assistant, is with the Clinical and Administrative Pharmacy, College of Pharmacy, University of Iowa, Iowa City, IA. Keela Herr, Ph.D., R.N., F.A.A.N., Professor and Area Chair, is with the Adult and Gerontological Nursing Area, University of Iowa College of Nursing, Iowa City, IA, and as Initiative Director with the John A. Hartford Center for Geriatric Nursing Excellence, University of Iowa College of Nursing, Iowa City, IA.

  • Marita G. Titler,

    1. University of Iowa Hospitals and Clinics, Iowa City, IA,
    2. Department of Nursing Services and Patient Care, University of Iowa Hospitals and Clinics, Iowa City, IA,
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  • Gail Ardery,

    1. Clinical and Administrative Pharmacy, College of Pharmacy, University of Iowa, Iowa City, IA,
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  • Keela Herr

    1. Adult and Gerontological Nursing Area, University of Iowa College of Nursing, Iowa City, IA,
    2. Center for Geriatric Nursing Excellence, University of Iowa College of Nursing, Iowa City, IA
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Abstract

Objectives. To estimate hospital cost changes associated with a behavioral intervention designed to increase the use of evidence-based acute pain management practices in an inpatient setting and to estimate the direct effect that changes in evidence-based acute pain management practices have on inpatient cost.

Data Sources/Study Setting. Data from a randomized “translating research into practice” (TRIP) behavioral intervention designed to increase the use of evidence-based acute pain management practices for patients hospitalized with hip fractures.

Study Design. Experimental design and observational “as-treated” and instrumental variable (IV) methods.

Data Collection/Extraction Methods. Abstraction from medical records and Uniform Billing 1992 (UB92) discharge abstracts.

Principal Findings. The TRIP intervention cost on average $17,714 to implement within a hospital but led to cost savings per inpatient stay of more than $1,500. The intervention increased the cost of nursing services, special operating rooms, and therapy services per inpatient stay, but these costs were more than offset by cost reductions within other cost categories. “As-treated” estimates of the effect of changes in evidence-based acute pain management practices on inpatient cost appear significantly underestimated, whereas IV estimates are statistically significant and are distinct from, but consistent with, estimates associated with the intervention.

Conclusions. A hospital treating more that 12 patients with acute hip fractures can expect to lower overall cost by implementing the TRIP intervention. We also demonstrated the advantages of using IV methods over “as-treated” methods to assess the direct effect of practice changes on cost.

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