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Improving the duration of airborne isolation for suspected pulmonary tuberculosis: cost-effectiveness analysis

Lin, Li (2019) Improving the duration of airborne isolation for suspected pulmonary tuberculosis: cost-effectiveness analysis. Master's Thesis, University of Pittsburgh. (Unpublished)

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Abstract

Background: Airborne isolation (AI) is an effective way to prevent the spread of tuberculosis (TB). When healthcare facilities are faced with patients with suspected pulmonary TB, they place patients in AI and order at least 3 specimens for acid-fast bacilli (AFB) smears and culture. The specimens are collected 8-24 hours apart with at least one morning specimen. When 3 consecutive specimens are negative on smears or another diagnosis is made, AI is discontinued. However, there is a significant delay in discontinuation of AI. Effective strategies are needed to shorten the duration in AI.
Public Health Significance: Delayed deisolation is associated with significant avoidable cost for the hospitals and patients without health insurance and related with preventable negative health effects on patients over-isolated.
Aims: The objective is to evaluate current practice of AI and improve the efficiency of deisolation for patients without contagious TB.
Method: Demographic and clinical information was reviewed from Jan 2015 to Dec 2017 at a 495-bed university-affiliated medical center. Cost-effectiveness analysis was performed to compare isolation with no isolation. TreeAge Pro 2018 Software was used to build a decision tree and make a sensitivity analysis.
Result: The positive rate of respiratory specimens is 6.3%. 93 patients had contagious TB excluded successfully with 3 consecutive negative AFB smears. AI is always cost-effective than no isolation despite the variation of its effectiveness. The average LOS in AI is 4.8 days. If LOS can be reduced to 2 days, the cost saving is $3,122 per patient. The total cost saving for 93 patients is $290,160.
Conclusion: This study shows a significant delay in deisolation for patients without contagious TB. More effective measures are needed to rule out TB timely. Improved efficiency in deisolation can contribute to a significant cost saving. Cost-effectiveness analysis will be a powerful aid to decision making that could engage hospital administration to improve the efficiency of deisolation.


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Details

Item Type: University of Pittsburgh ETD
Status: Unpublished
Creators/Authors:
CreatorsEmailPitt UsernameORCID
Lin, Lilil126@pitt.edulil126
ETD Committee:
TitleMemberEmail AddressPitt UsernameORCID
Committee ChairMattila, Joshuajmattila@pitt.edujmattila
Committee CoChairYassin, Mohamedmhy8@pitt.edumhy8
Committee MemberChen, Yuecheny@pitt.educheny
Date: 30 January 2019
Date Type: Publication
Defense Date: 30 November 2018
Approval Date: 30 January 2019
Submission Date: 26 November 2018
Access Restriction: 3 year -- Restrict access to University of Pittsburgh for a period of 3 years.
Number of Pages: 49
Institution: University of Pittsburgh
Schools and Programs: Graduate School of Public Health > Infectious Diseases and Microbiology
Degree: MPH - Master of Public Health
Thesis Type: Master's Thesis
Refereed: Yes
Uncontrolled Keywords: TB; airborne isolation; discontinuation of isolation
Date Deposited: 30 Jan 2019 17:38
Last Modified: 30 Jan 2019 17:38
URI: http://d-scholarship.pitt.edu/id/eprint/35569

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