This report from KPMG presents the findings of a qualitative study into reducing pressure injuries in New Zealand.
Pressure injuries are a major cause of preventable harm for healthcare services including hospital, residential aged care and home care in New Zealand. Approximately 4-8% of those that receive healthcare in New Zealand experience a PI, regardless of their age or mobility1. PI reduces quality of life for sufferers and have a profound human cost including; constant pain, loss of function and mobility, depression, distress and anxiety, embarrassment and social isolation, increased financial burdens, prolonged hospital stays, septicaemia, and even death.
Purpose
The purpose of this project was to determine a value proposition for investment in a national quality improvement programme to reduce the incidence of Pressure Injuries (PI) in the New Zealand Health Sector.
Methodology
To quantify the incidence and impact of PI to the health sector of New Zealand, a four-step approach was applied:
1 A review of key literature, and of both international and local experience in PI reduction.
2 A series of stakeholder workshops to identify the current New Zealand PI initiatives and their relative success. This included identification of perceived barriers to reducing PI and improving the quality of care, gaining a better understanding of what works, what does not, and the reasons why in various clinical settings.
3 Develop a simulation model to estimate the incidence of PI in New Zealand by healthcare setting by:
• Using data from the National Minimum Data Set (NMDS) for hospital patients, interRAI data for home care and residential aged care
• Applying prevalence data from The Northern DHB Alliance to estimate incidence and severity. This was risk adjusted using patient age, procedure, complexity and setting (e.g. intensive care or rehabilitation wards).
4 Build an investment model to determine the cost benefit of the proposed programme:
• Developing a cost profile per patient for both treatment and loss of quality of life (QoL). Direct cost included clinical time and consumables, extended length of stay (LOS), post discharge primary care and allied health, and readmission for rehabilitation. Grade I and II PI were assumed to fully resolve by the end of the first year and therefore loss of QoL was attributed only to year one. However, for Grade III and IV PI the loss of QoL was calculated over remaining life years using statistical life tables.
• Developing an investment profile aligning each investment with potential benefits in terms of direct cost savings. This was based on the four recommended solution sets for the national quality improvement programme and provided a multiagency approach.
• Developing a PI reduction profile based on the expected reduction in the incidence of each grade of PI in each year of the programme, over a ten year timeframe.
• Deriving cost benefit ratios for the investment to the PI programme for each agency. Cost benefit ratios were calculated on two levels; direct cost savings to the provider and total cost savings to the nation (i.e. providers and patients).
• Qualifying the model by conducting a sensitivity analysis on the expected rate of PI reduction and impact of delays to the programme, reflecting a change in cost benefit ratio, and Net Present Value (NPV) of the investment.