Abstract
Objectives
The ‘Intervention for Appropriate Care and Treatment’ (InterACT) was a nudge intervention to identify hospital patients at risk of imminent death or deterioration and communicate this information to treating clinical teams. The aim was to improve the quality of the care delivered. This paper reports an economic evaluation of the InterACT intervention.
Methods
A stepped-wedge cluster randomised trial was conducted across three large tertiary hospitals in Australia between May 2020 and June 2021. We report the data as a cost-consequence analysis here. The cost of implementing the intervention was determined using prospectively collected staff time sheets, study documentation and field notes. Changes to hospital admission costs and health service outcomes between the trial’s intervention and control phases are also reported. Hospital admissions costs and other health service outcomes were obtained from hospital databases and patient chart reviews.
Results
The mean intervention cost was $72 per at-risk patient admission identified. Additional site-level implementation costs ranged between $21,373 to $34,867 per hospital site, translating to $23 per at-risk admission. The intervention did not reduce the cost of ICU admission, length of stay, medical emergency calls or in-hospital deaths. Wide confidence intervals around at-risk admission cost differences (95% CI: –$2,264 to $3,312) indicated there was large uncertainty.
Conclusions
This cost-consequence analysis found that the intervention was not effective in reducing the cost of non-beneficial treatment, which is consistent with the broader InterACT results. This simple nudge- intervention alone may not be sufficient to impact health service resource use and costs in the complex end-of-life setting.
The ‘Intervention for Appropriate Care and Treatment’ (InterACT) was a nudge intervention to identify hospital patients at risk of imminent death or deterioration and communicate this information to treating clinical teams. The aim was to improve the quality of the care delivered. This paper reports an economic evaluation of the InterACT intervention.
Methods
A stepped-wedge cluster randomised trial was conducted across three large tertiary hospitals in Australia between May 2020 and June 2021. We report the data as a cost-consequence analysis here. The cost of implementing the intervention was determined using prospectively collected staff time sheets, study documentation and field notes. Changes to hospital admission costs and health service outcomes between the trial’s intervention and control phases are also reported. Hospital admissions costs and other health service outcomes were obtained from hospital databases and patient chart reviews.
Results
The mean intervention cost was $72 per at-risk patient admission identified. Additional site-level implementation costs ranged between $21,373 to $34,867 per hospital site, translating to $23 per at-risk admission. The intervention did not reduce the cost of ICU admission, length of stay, medical emergency calls or in-hospital deaths. Wide confidence intervals around at-risk admission cost differences (95% CI: –$2,264 to $3,312) indicated there was large uncertainty.
Conclusions
This cost-consequence analysis found that the intervention was not effective in reducing the cost of non-beneficial treatment, which is consistent with the broader InterACT results. This simple nudge- intervention alone may not be sufficient to impact health service resource use and costs in the complex end-of-life setting.
| Original language | English |
|---|---|
| Article number | afaf280 |
| Pages (from-to) | 1-8 |
| Number of pages | 8 |
| Journal | Age and Ageing |
| Volume | 54 |
| Issue number | 10 |
| DOIs | |
| Publication status | Published - Oct 2025 |