Health and Economic Burden of Post-Partum Staphylococcus aureus Breast Abscess

Objectives: To determine the health and economic burdens of post-partum Staphylococcus aureus breast abscess. Study design We conducted a matched cohort study (N = 216) in a population of pregnant women (N = 32,770) who delivered at our center during the study period from 10/1/03–9/30/10. Data were extracted from hospital databases, or via chart review if unavailable electronically. We compared cases of S. aureus breast abscess to controls matched by delivery date to compare health services utilization and mean attributable medical costs in 2012 United States dollars using Medicare and hospital-based estimates. We also evaluated whether resource utilization and health care costs differed between cases with methicillin-resistant and -susceptible S. aureus isolates. Results: Fifty-four cases of culture-confirmed post-partum S. aureus breast abscess were identified. Breastfeeding cessation (41%), milk fistula (11.1%) and hospital readmission (50%) occurred frequently among case patients. Breast abscess case patients had high rates of health services utilization compared to controls, including high rates of imaging and drainage procedures. The mean attributable cost of post-partum S. aureus breast abscess ranged from $2,340–$4,012, depending on the methods and data sources used. Mean attributable costs were not significantly higher among methicillin-resistant vs. –susceptible S. aureus cases. Conclusions: Post-partum S. aureus breast abscess is associated with worse health and economic outcomes for women and their infants, including high rates of breastfeeding cessation. Future study is needed to determine the optimal treatment and prevention of these infections

Robotic Assistance in Coordination of Patient Care

We conducted a study to investigate trust in and dependence upon robotic decision support among nurses and doctors on a labor and delivery floor. There is evidence that suggestions provided by embodied agents engender inappropriate degrees of trust and reliance among humans. This concern is a critical barrier that must be addressed before fielding intelligent hospital service robots that take initiative to coordinate patient care. Our experiment was conducted with nurses and physicians, and evaluated the subjects’ levels of trust in and dependence on high- and low-quality recommendations issued by robotic versus computer-based decision support. The support, generated through action-driven learning from expert demonstration, was shown to produce high-quality recommendations that were ac- cepted by nurses and physicians at a compliance rate of 90%. Rates of Type I and Type II errors were comparable between robotic and computer-based decision support. Furthermore, em- bodiment appeared to benefit performance, as indicated by a higher degree of appropriate dependence after the quality of recommendations changed over the course of the experiment. These results support the notion that a robotic assistant may be able to safely and effectively assist in patient care. Finally, we conducted a pilot demonstration in which a robot assisted resource nurses on a labor and delivery floor at a tertiary care center.National Science Foundation (U.S.) (Grant 2388357

Robotic assistance in the coordination of patient care

We conducted a study to investigate trust in and dependence upon robotic decision support among nurses and doctors on a labor and delivery floor. There is evidence that suggestions provided by embodied agents engender inappropriate degrees of trust and reliance among humans. This concern represents a critical barrier that must be addressed before fielding intelligent hospital service robots that take initiative to coordinate patient care. We conducted our experiment with nurses and physicians, and evaluated the subjects’ levels of trust in and dependence upon high- and low-quality recommendations issued by robotic versus computer-based decision support. The decision support, generated through action-driven learning from expert demonstration, produced high-quality recommendations that were accepted by nurses and physicians at a compliance rate of 90%. Rates of Type I and Type II errors were comparable between robotic and computer-based decision support. Furthermore, embodiment appeared to benefit performance, as indicated by a higher degree of appropriate dependence after the quality of recommendations changed over the course of the experiment. These results support the notion that a robotic assistant may be able to safely and effectively assist with patient care. Finally, we conducted a pilot demonstration in which a robot-assisted resource nurses on a labor and delivery floor at a tertiary care center.National Science Foundation Graduate Research Fellowship Program (Grant 23883577

Health Services Utilization and Clinical Outcomes: Comparing MRSA to MSSA Cases of Post-partum <i>Staphylococcus aureus</i> Breast Abscess During the Year after Post-Partum Discharge.

1<p>Wilcoxon rank-sum test, Chi-square, or Fisher’s Exact Test used as appropriate.</p>2<p>Data missing for 5/54 patients.</p>3<p>Includes only severe adverse allergic reactions, including hives and severe skin rash. Minor complications excluded.</p>4<p>Includes relevant office visits to obstetrics and gynecology (excluding routine post-partum care, preventive care, and visits for contraception), infectious diseases, breast surgery, internal medicine, and dermatology. No patients in the matched cohort study received allergy and immunology outpatient visits.</p

Cost Estimate Methodologies.

1<p>HSU = Health services utilization. Cost per service based on Medicare Fee Schedules.</p>2<p>Direct medical costs include those directly related to services provided, such as inpatient stay, outpatient office visits, laboratory and radiographic testing.</p>3<p>Indirect medical costs include facility operating costs, such as building costs, electricity costs, and costs of equipment.</p>4<p>“All” indicates that all direct medical costs, including those that may not be related to a diagnosis of post-partum breast abscess were included in the estimate of cost. “Potentially relevant” indicates that only direct medical costs related to potentially relevant services (such as visits to internal medicine, obstetrics, infectious diseases, and radiology) were included in the estimate of cost. “Disease-attributable” indicates that only services attributable to the diagnosis of post-partum breast abscess were included in the estimate of cost.</p

Healthcare Costs of Post-partum <i>Staphylococcus aureus</i> Breast Abscess Compared to Non-infected Controls.

1<p>Includes all direct healthcare costs based on hospital fiscal databases during the one-year period following post-partum discharge.</p>2<p>Includes only potentially relevant healthcare costs based on hospital fiscal databases, such as inpatient readmission, relevant outpatient office visits, radiology, and laboratory costs.</p>3<p>Estimated by multiplying the number of units of each relevant healthcare service by Medicare reimbursement for each service.</p

Health Services Utilization and Clinical Outcomes Among Women During the Year After Post-Partum Discharge: Matched Cohort Study Results.

1<p>Wilcoxon rank-sum test, Fisher’s exact test or Chi square test used as appropriate.</p>2<p>During the one-year period following post-partum discharge. Includes oral and intravenous antibiotics.</p>3<p>Includes relevant office visits to obstetrics and gynecology (excluding routine post-partum care, preventive care, and visits for contraception), infectious diseases, breast surgery, internal medicine, and dermatology. No patients in the matched cohort study had allergy/immunology outpatient visits.</p