contains the mean of each dependent variable used in the analysis and the estimates of the effect of the behavioral intervention on each of the dependent variables. The patients in our sample received an average of 8.53 of the 18 evidence-based pain management practices within the summative index. The range of the summative index score in the sample was 1–18 with 80 percent of the sample having index scores between 5 and 12. Patients at intervention hospitals during the intervention phase had an average of 0.94 additional evidence-based acute pain management practices performed (p<.001) relative to patients at the comparison hospitals. The effects of the intervention on individual acute pain management practices are not reported in , but the intervention had a significant and positive impact (p<.05) on 11 of the 18 practices listed in (practices 1 through 6, 9, 12, 13, 15, and 17).
The Effect of the Intervention on Pain Practices, Inpatient Costs, and Length-of-Stay
The intervention reduced the cost of an average inpatient stay by a little over $1,500 (p<.001). Therefore, a hospital treating 100 acute hip fracture patients could expect a reduction in patient treatment costs of over $150,000 from implementing the intervention. The cost reduction per inpatient stay stemmed from a nearly half a day reduction in LOS (p=.055), and a reduction of over $150 in cost per day (p=.010). The intervention increased “extra nursing” cost (p=.002) and the cost associated with special nonoperating rooms (p=.011). These cost increases were more than offset, though, by reductions in room and board (p<.001), pharmacy (p<.001), laboratory services (p<.001), radiation services (p=.006), operating room (p<.001), pulmonary and respiratory services (p=.004), anesthesia (p=.002), emergency room services (p=.024), and blood supplies (p=.019). Using the intervention cost data collected throughout the study, the average direct cost to implement the TRIP intervention at intervention hospitals equaled $17,714. Therefore, a hospital treating 100 acute hip fracture patients could expect an overall cost reduction of $132,286 ($150,000–$17,714) from implementing the TRIP intervention. A hospital would only need to treat more than 12 acute hip fracture patients to realize cost-savings from the TRIP intervention.
contains estimates of the direct effect of the summative index score on the cost and LOS. The first three columns contain the estimates of the “as-treated” analysis. These results suggest that an increase in the number of evidence-based acute pain management practices has little effect on inpatient cost and LOS. In contrast, the IV estimates in show that a unit change in the summative index score led to over a $1,600 drop in total inpatient cost (p
=.003) which stems mainly from a reduction of over $161 cost per day (p
=.040). LOS also fell by a half a day with a unit increase in the summative index score, but was not statistically significant. The relationship between the IV estimates and the direct estimates from the intervention as described by Kaufman, Kaufman, and Poole (2003)
can be seen in our results in and . The parameter b
, the change in the summative index level that resulted from the intervention equals 0.9365637 and the parameter d
, the change in total cost that resulted from the intervention, equals $−1,500.362. The ratio of d
is $−1,601.99 which is the IV estimate in of the change in total cost from increased use of evidence-based acute pain management practices.
Alternative Estimates of the Average Effect of an Increase in Acute Pain Management Practices (Summative Index Score) on Cost and Length-of-Stay