Impact of medical microbiology: A clinical and financial analysis

To be able to provide cost-effective healthcare, it is important to evaluate the impact of interventions. This thesis looked at interventions performed by the Department of Medical Microbiology at the University Medical Center Groningen. This department plays an important role in infection management and controlling antimicrobial resistance. We developed an integrative infection management model: the Antimicrobial, Infection Prevention and Diagnostic (AID) Stewardship Program; and argue that all three areas are essential for good quality of care. For each area, interventions were evaluated. The implemented intervention for Antimicrobial Stewardship (day-2 bundle) reduced length of stay for a subset of patients, with a positive return on investment. Regarding Infection Prevention Stewardship, costs of outbreaks with (resistant) microorganisms were substantial (€519 per patient per day). Furthermore, increasingly more patients enter the hospital carrying these bacteria, increasing outbreak risks. However, number of outbreak patients remained stable, suggesting a positive impact of increased infection prevention measures. Also here, predicted benefits outweighed costs. Finally, effects of taking blood cultures were evaluated as part of Diagnostic Stewardship. Blood cultures were performed for just 48% of the evaluated patients receiving antibiotics intravenously. We showed that taking blood cultures was associated with a shorter length of stay of these patients. In conclusion, good infection management has highly positive effects on patients and finances. To stimulate appropriate infection management, to create financial incentives and provide more clarity in internal budgeting, we argue for implementation of an innovative infection prevention insurance system, and process-oriented, quality-driven cost-effectiveness analyses to guide decisions.