Cost-effectiveness analysis of the Pediatric Hospital Improvement Initiative in Nicaragua

The Pediatric Hospital Initiative was launched by Nicargua's Ministrio de Salud (MINSA) in partnership with UNICEF and USAID though the Quality Assurance Project (QAP) and its successor the Health Care Improvement Project (HCI). The initiative worked to improve the quality of care provided in hospital pediatric wards to children with common infectious diseases. The initiative involved 14 hospitals, which were organized into an improvement collaborative, and focused on children affected by diarrhea and pneumonia.

This study used a longitudinal pre/post design using data from medical records of inpatient admissions to examine the cost effectiveness of PHI initiatives, as measured by the impact on days of hospitalization, disability adjusted life years (DALYs), and deaths attributed to diarrhea or pneumonia from seven of the collaborative hospitals, which were selected based on a minimum criteria of two years of surveillance data for the indicators of interest and where QI teams were actively engaged in monitoring and evaluation of the program and implementing improvement cycles. A total of 2,799 records were examined: 647 records from the year prior to the collaborative and 750 after the collaborative for diarrhea and 647 records before and 755 after for pneumonia.Costs were calculated retrospectively. Those paid by HCI and its partners were determined by the project's accounting records. Hospitalization costs were calculated from a mix of available data from the public sector such as published salary rates and price lists of basic medicines, and from equivalent private sector costs for items such as laboratory blood tests and chest radiographs for pneumonia patients because public hospitals do not account for clinical line items such as these.
The study shows that implementation of the quality improvement collaborative decreased patients' length of stay and the number of deaths and did not increase the cost of hospitalization for diarrhea and pneumonia cases, meaning that the QI collaborative improved health outcomes while decreasing costs to the hospital system.

This study was published in the Pan American Journal of Public Health.



Report Author(s): 
E Broughton, I Gomez, O Nunez, J Wong
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