COMPARING EVIDENCE-BASED DECISION TOOLS TO CHECKLISTS FOR THE PREVENTION OF HOSPITAL-ACQUIRED CONDITIONS: A VALUE OF INFORMATION ANALYSIS

Purpose: The intention is to analyze the value of information associated with organzing evidence-based practices (EBPs) into decision tools compared to checklists for the prevention of hospital-acquired conditions. EBPs have been developed as guidelines for providers to implement for preventing several conditions: surgical site infections (SSI); central line-associated bloodstream infections (CLABSI); pressure ulcers (PrU); and catheter-associated urinary tract infections (CAUTI). Checklists can assist providers to track completion of EBPs linearly; whereas, decision tools offer providers an opportunity to better characterize patient preferences.

Method: A network meta-analysis pooled outcomes data of "checklists" and "decision tools" tested in "randomized controlled trials" for the prevention of hospital-acquired conditions. The systematic review identified studies about prevention of SSI, CLABSI, PrUs and CAUTI meeting search criteria. Odds-ratios were calculated for preventing complications or death associated with each condition as a result of implementing checklists or decision tools in the hospital setting. The review also collected data on the cost and health utility of each condition.

Four decision trees were used to analyze the cost-effectiveness by preventing SSIs, CLABI, PrUs or CAUTI through the deployment of either a decision tool or checklist based on probabilities calculated from the network meta-analysis. Each 1-year model simulated the prevention of a complication associated with higher utility and lower cost, or a hospital-acquired condition leading to excess costs and disutility or death. Health utility was measured as quality-adjusted life years (QALYs), and costs were adjusted for inflation to 2013 $US. Univariate sensitivity analyses and microsimulations, and a Bayesian multivariate probablistic sensitivity analysis using 10,000 Monte Carlo simulations were conducted to test model uncertainty. Findings were interpreted from a willingness-to-pay of $100,000/QALY.

Results: In each hospital-acquired condition case, decision tools were cost-effective compared to checklists for implementing EBPs. Univariate microsimulations were robust to changes in results with the exception of CAUTI, where 25% of iterations favored checklists over decision tools as more cost-effective. The multivariate probabilistic sensitivity analyses of each model showed that decision tools were cost-effective relative to checklists in approximately 90-95% of simulations.

Conclusion: This analysis determines that information from EBPs formatted as decision tools holds greater value than checklists for preventing hospital-acquired conditions. The dynamic nature of decision tools apply well to heterogenous patient populations by improving patient-centered care in the hospital setting.