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Clinical Research
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An economic evaluation of skin damage prevention regimens among nursing home residents with incontinence: labor costs Donna Z. Bliss, Cindy Zehrer, Kay Savik, Li Ding, Edwin Hedblom, 3M, St. Paul, MN Purpose: Reports of high rates of incontinence in nursing home (NH) residents suggest prevention of incontinence dermatitis (ID) is a major concern. Little is known about the cost of ID prevention. The purpose of this study was to examine cost-effectiveness of four ID prevention regimens in NH residents. Staff labor costs of the regimens are reported Methods: Residents (n=1,918) in 16 US NHs, randomly selected, were screened for eligibility; 981 residents qualified and were enrolled. All were incontinent were free of perineal skin damage. Age and sex did not differ among the groups (P>.05). Regimens included a barrier film applied 3 times weekly (A) or one of three ointment barriers of different composition applied after each incontinence episode (B, C, D). Measures of caregiver labor (number and time) for ID prevention on 888 qualified residents (712 women; age < 90 years = 72%, > 90 years = 28%) were used in the economic analysis. Staff assessed resident skin damage for 6 weeks to determine efficacy of the regimens Results: Overall occurrence of skin damage was 4.6% of which 74% was attributed to ID; neither incidence differed significantly among the groups (P>.05 for both). The median number of incontinence episodes/day differed among the groups (A=6.3, B=6.3, C=7.0, D=6.7; P=.005). Different numbers of staff provided ID prevention care (range = 1 to 4; P<.001). Due to these differences, the analysis standardized the cost of staff labor per 100 episodes of incontinence provided by one or two caregivers. The median total labor cost of regimen A($23.71) was significantly less than B($96.96), C($43.92), and D($52.32) P<.001. Median labor cost of applying barrier A($1.15) was less than B($15.84), C($17.04), and D($16.32) P<.001 Conclusion: Use of a skin barrier film applied 3 times weekly is effective in preventing ID and saves significant staff labor costs. |
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