{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,12]],"date-time":"2026-03-12T00:37:13Z","timestamp":1773275833321,"version":"3.50.1"},"reference-count":24,"publisher":"Public Library of Science (PLoS)","issue":"8","license":[{"start":{"date-parts":[[2024,8,15]],"date-time":"2024-08-15T00:00:00Z","timestamp":1723680000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Background<\/jats:title>\n<jats:p>Management of sedation, analgesia, and delirium influences morbidity, mortality, and quality of life in patients treated in intensive care. Assessing quality indicators as part of a quality management and assurance program is an established method to ensure process quality. Currently, there is limited research on the effect of evaluating quality indicators on economic outcomes. The aim of the study was to investigate the adherence to an indicator on management of sedation, analgesia and delirium, and explore potential effects on hospital economics and clinical outcomes.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Methods<\/jats:title>\n<jats:p>In this retrospective cohort study, we analyzed routine data from 20,220 patient records from the hospital information system of a tertiary university hospital, collected from January 2012 to December 2019. We compared two predefined subgroups with either high indicator adherence or low indicator adherence regarding factors like disease severity scores, comorbidities, and outcome measures. We used logistic regression models to examine the influence of quality indicator adherence on economic measures such as Diagnosis-related group (DRG) incomes, revenue margins, and costs, and clinical outcomes. Additionally, we used propensity score matching to probe our findings.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Results<\/jats:title>\n<jats:p>Overall revenue margins in this cohort were negative (-320\u20ac). High adherence to the quality indicator was associated with a positive revenue margin (+197\u20ac) compared to low adherence (-482\u20ac). Higher adherence was also associated with lower costs. Additionally, high adherence was associated with reduced mortality (OR 0.84, 95% CI 0.75\u20130.95) and reduced duration of mechanical ventilation and hospital stay (17 hours and 1 day respectively).<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Conclusion<\/jats:title>\n<jats:p>Higher adherence to a quality indicator for sedation, analgesia, and delirium management was associated with economic returns and costs. We also found an association with lower mortality and reduced length of stay. Further research on these associations may help identify opportunities for quality improvement without increased resource use.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0308948","type":"journal-article","created":{"date-parts":[[2024,8,15]],"date-time":"2024-08-15T17:35:55Z","timestamp":1723743355000},"page":"e0308948","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":4,"title":["The impact of adhering to a quality indicator for sedation, analgesia, and delirium management on costs, revenues, and clinical outcomes in intensive care in Germany: A retrospective observational study"],"prefix":"10.1371","volume":"19","author":[{"given":"Alexander","family":"Zuber","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6174-6346","authenticated-orcid":true,"given":"Kerstin","family":"Rubarth","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9701-7620","authenticated-orcid":true,"given":"Frank","family":"F\u00f6rster","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1575-2056","authenticated-orcid":true,"given":"Felix","family":"Balzer","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Claudia","family":"Spies","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8490-7707","authenticated-orcid":true,"given":"Daniel","family":"F\u00fcrstenau","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Oliver","family":"Kumpf","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"340","published-online":{"date-parts":[[2024,8,15]]},"reference":[{"issue":"1","key":"pone.0308948.ref001","first-page":"17","article-title":"[Quality indicators in intensive care medicine: Background and practical use].","volume":"116","author":"O. Kumpf","year":"2021","journal-title":"Med Klin Intensivmed Notfmed"},{"key":"pone.0308948.ref002","first-page":"Doc09","article-title":"The future development of intensive care quality indicators\u2014a methods paper","volume":"18","author":"O Kumpf","year":"2020","journal-title":"German medical science: GMS e-journal"},{"issue":"4","key":"pone.0308948.ref003","first-page":"202","article-title":"National ICU Quality Indicators Revisited.","author":"H. Flaatten","year":"2016","journal-title":"ICU Managment & Practice."},{"key":"pone.0308948.ref004","first-page":"Doc10","article-title":"Quality indicators in intensive care medicine for Germany\u2014third edition 2017","volume":"15","author":"O Kumpf","year":"2017","journal-title":"German medical science: GMS e-journal"},{"issue":"6","key":"pone.0308948.ref005","first-page":"479","article-title":"[Delirium-assessment, prevention and treatment: Task in the interprofessional intensive care unit team].","volume":"117","author":"C Hermes","year":"2022","journal-title":"Med Klin Intensivmed Notfmed"},{"issue":"3","key":"pone.0308948.ref006","doi-asserted-by":"crossref","first-page":"207","DOI":"10.1002\/ams2.337","article-title":"Comparison of clinical practice guidelines for the management of pain, agitation, and delirium in critically ill adult patients.","volume":"5","author":"R Tsuruta","year":"2018","journal-title":"Acute Med Surg."},{"issue":"1","key":"pone.0308948.ref007","doi-asserted-by":"crossref","first-page":"66","DOI":"10.1007\/s00134-006-0399-8","article-title":"Incidence, risk factors and consequences of ICU delirium.","volume":"33","author":"S Ouimet","year":"2007","journal-title":"Intensive care medicine."},{"issue":"1","key":"pone.0308948.ref008","first-page":"65","article-title":"[Delirium, analgesia, and sedation in intensive care medicine: Development of a protocol-based management approach].","volume":"112","author":"A Wolf","year":"2017","journal-title":"Med Klin Intensivmed Notfmed."},{"key":"pone.0308948.ref009","doi-asserted-by":"crossref","first-page":"28","DOI":"10.1016\/j.zefq.2022.02.001","article-title":"Hospitalisation costs and health related quality of life in delirious patients: a scoping review.","volume":"169","author":"C van Lieshout","year":"2022","journal-title":"Z Evid Fortbild Qual Gesundhwes"},{"issue":"1","key":"pone.0308948.ref010","doi-asserted-by":"crossref","first-page":"21","DOI":"10.1345\/aph.1Q284","article-title":"I-SAVE study: impact of sedation, analgesia, and delirium protocols evaluated in the intensive care unit: an economic evaluation","volume":"46","author":"DK Awissi","year":"2012","journal-title":"Ann Pharmacother"},{"issue":"9","key":"pone.0308948.ref011","doi-asserted-by":"crossref","first-page":"e0234801","DOI":"10.1371\/journal.pone.0234801","article-title":"Effects of pain, sedation and delirium monitoring on clinical and economic outcome: A retrospective study.","volume":"15","author":"M Deffland","year":"2020","journal-title":"PLoS One."},{"issue":"1","key":"pone.0308948.ref012","doi-asserted-by":"crossref","first-page":"e045327","DOI":"10.1136\/bmjopen-2020-045327","article-title":"Does adherence to a quality indicator regarding early weaning from invasive ventilation improve economic outcome? A single-centre retrospective study","volume":"12","author":"A Zuber","year":"2022","journal-title":"BMJ open"},{"issue":"1","key":"pone.0308948.ref013","doi-asserted-by":"crossref","first-page":"12","DOI":"10.1016\/j.jcrc.2004.09.007","article-title":"A systematic review of the Charlson comorbidity index using Canadian administrative databases: a perspective on risk adjustment in critical care research.","volume":"20","author":"DM Needham","year":"2005","journal-title":"J Crit Care"},{"issue":"2","key":"pone.0308948.ref014","doi-asserted-by":"crossref","first-page":"191","DOI":"10.1007\/s00134-022-06949-x","article-title":"Effectiveness of an intensive care telehealth programme to improve process quality (ERIC): a multicentre stepped wedge cluster randomised controlled trial.","volume":"49","author":"CD Spies","year":"2023","journal-title":"Intensive care medicine."},{"issue":"11","key":"pone.0308948.ref015","doi-asserted-by":"crossref","first-page":"e32264","DOI":"10.2196\/32264","article-title":"Telemedicine in Intensive Care Units: Scoping Review.","volume":"23","author":"C Guinemer","year":"2021","journal-title":"J Med Internet Res"},{"issue":"9","key":"pone.0308948.ref016","doi-asserted-by":"crossref","first-page":"1277","DOI":"10.1001\/jamainternmed.2016.2427","article-title":"Associations Between Ventilator Bundle Components and Outcomes.","volume":"176","author":"M Klompas","year":"2016","journal-title":"JAMA Intern Med"},{"issue":"2","key":"pone.0308948.ref017","doi-asserted-by":"crossref","first-page":"R42","DOI":"10.1186\/cc13755","article-title":"Impact of compliance with infection management guidelines on outcome in patients with severe sepsis: a prospective observational multi-center study.","volume":"18","author":"F Bloos","year":"2014","journal-title":"Critical care."},{"issue":"5","key":"pone.0308948.ref018","first-page":"505","article-title":"Cost of intensive care in a German hospital: cost-unit accounting based on the InEK matrix","volume":"57","author":"J Martin","year":"2008","journal-title":"Der Anaesthesist"},{"issue":"1","key":"pone.0308948.ref019","doi-asserted-by":"crossref","first-page":"248","DOI":"10.1186\/s13054-015-0947-0","article-title":"Is critical care ready for an economic surrogate endpoint?","volume":"19","author":"ME Wilcox","year":"2015","journal-title":"Critical care."},{"issue":"7824","key":"pone.0308948.ref020","doi-asserted-by":"crossref","first-page":"193","DOI":"10.1038\/s41586-020-2669-y","article-title":"Illuminating the dark spaces of healthcare with ambient intelligence","volume":"585","author":"A Haque","year":"2020","journal-title":"Nature"},{"issue":"7","key":"pone.0308948.ref021","first-page":"567","article-title":"[Cost analysis as a tool for assessing the efficacy of intensive care units].","volume":"113","author":"T Maierhofer","year":"2018","journal-title":"Med Klin Intensivmed Notfmed"},{"issue":"12","key":"pone.0308948.ref022","first-page":"2940","article-title":"How Denmark, England, Estonia, France, Germany, and the USA Pay for Variable, Specialized and Low Volume Care: A Cross-country Comparison of In-patient Payment Systems.","volume":"11","author":"W Quentin","year":"2022","journal-title":"Int J Health Policy Manag."},{"issue":"7","key":"pone.0308948.ref023","article-title":"Pay for performance for hospitals.","author":"T Mathes","year":"2019","journal-title":"Cochrane Database of Systematic Reviews."},{"issue":"4","key":"pone.0308948.ref024","doi-asserted-by":"crossref","first-page":"575","DOI":"10.1097\/CCM.0000000000004851","article-title":"Health-Related Quality-of-Life and Cost Utility Analyses in Critical Care: A Systematic Review*.","volume":"49","author":"VI Lau","year":"2021","journal-title":"Critical care medicine."}],"container-title":["PLOS ONE"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0308948","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,8,15]],"date-time":"2024-08-15T17:36:16Z","timestamp":1723743376000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0308948"}},"subtitle":[],"editor":[{"given":"Patricia Rezende","family":"do Prado","sequence":"first","affiliation":[],"role":[{"role":"editor","vocabulary":"crossref"}]}],"short-title":[],"issued":{"date-parts":[[2024,8,15]]},"references-count":24,"journal-issue":{"issue":"8","published-online":{"date-parts":[[2024,8,15]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0308948","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,8,15]]}}}