RESUMO
With global estimates of 15 million cases of sepsis annually, together with a 24% in-hospital mortality rate, this condition comes at a high cost to both the patient and to the health services delivering care. This translational research determined the cost-effectiveness of state-wide implementation of a whole of hospital Sepsis Pathway in reducing mortality and/or hospital admission costs from a healthcare sector perspective, and report the cost of implementation over 12-months. A non-randomised stepped wedge cluster implementation study design was used to implement an existing Sepsis Pathway ("Think sepsis. Act fast") across 10 of Victoria's public health services, comprising 23 hospitals, which provide hospital care to 63% of the State's population, or 15% of the Australian population. The pathway utilised a nurse led model with early warning and severity criteria, and actions to be initiated within 60 minutes of sepsis recognition. Pathway elements included oxygen administration; blood cultures (x2); venous blood lactate; fluid resuscitation; intravenous antibiotics, and increased monitoring. At baseline there were 876 participants (392 female (44.7%), mean 68.4 years); and during the intervention, there were 1,476 participants (684 female (46.3%), mean 66.8 years). Mortality significantly reduced from 11.4% (100/876) at baseline to 5.8% (85/1,476) during implementation (p>0.001). Respectively, at baseline and intervention the average length of stay was 9.1 (SD 10.3) and 6.2 (SD 7.9) days, and cost was $AUD22,107 (SD $26,937) and $14,203 (SD $17,611) per patient, with a significant 2.9 day reduction in length of stay (-2.9; 95%CI -3.7 to -2.2, p<0.01) and $7,904 reduction in cost (-$7,904; 95%CI -$9,707 to -$6,100, p<0.01). The Sepsis Pathway was a dominant cost-effective intervention due to reduced cost and reduced mortality. Cost of implementation was $1,845,230. In conclusion, a well-resourced state-wide Sepsis Pathway implementation initiative can save lives and dramatically reduce the health service cost per admission.
RESUMO
The child victimization rate in the US has rapidly grown over the past five years. Today, nine out of every 1000 children are victims of some type of child maltreatment, and lifetime costs of child victimization exceed $100 billion per year. Effective policies promoting fairness and child safety must target the most salient indicators of child maltreatment. In this study, we examined three groups of risk factors for child abuse potential with the goal of identifying the most prominent indicators in a sample of 170 African-American and Latina mothers. Specifically, we analyzed the effect of socio-demographic variables (e.g., SES), child-specific behaviors, maternal trauma and corresponding psychological sequelae on child abuse potential. Variables from all three groups were significantly associated with child abuse potential with maternal SES, alexithymia, depression, and child self-control as well as internalizing behaviors having the largest effects. All factors combined captured over 50% of the variation in child abuse potential. The results highlight the need for programs that not only address the financial needs of low SES mothers, but also the mental health outcomes correlated with low SES. Particular emphasis should also be placed on interventions that address children's social needs, specifically their socio-emotional functioning.