Correlates and Economic Outcomes of Inpatient Intravenous Chlorothiazide Use - A Retrospective Study
Objectives: The hospital study objectives were 1) to evaluate frequency of appropriate/inappropriate chlorothiazide (IVCTZ) use as per hospital protocol criteria and 2) to compare estimated IVCTZ costs between appropriate and inappropriate IVCTZ use patients. Methods: This is a 2-year (2012-2014) retrospective study. Patient data (age, hospital-LOS, urine-output (24 hour pre-, post-IVCTZ), serviceunit (ICU/other), IV-loop-diuretic and IVCTZ dose, frequency, duration) were collected from the hospital’s Sunrise-Clinical-Manager database. IVCTZ initiation was “appropriate” if patients had: 1) received high-dose IV loopdiuretics and 2) received at least two oral thiazide doses before IVCTZ, when on other oral medications. Results: Majority (80%, 56/70) of patients received IVCTZ “inappropriately”, 82% had not received high-dose IV loop-diuretics, 53% had not received at least two oral thiazide doses despite being on oral medications, and none qualified for “appropriate” group when 24 hour pre-IVCTZ urine- output (<480 ml/day) and other criteria considered. The greater two-year IVCTZ costs in the inappropriate versus appropriate ($84, 840 vs. $56, 160) group suggest missed IVCTZ cost-saving opportunities. Conclusions: Hospital payers and providers efforts to promote appropriate IVCTZ use by re-evaluating the protocol inclusion-criteria of urine-output and maximizing high-dose loop-diuretic use before initiating IVCTZ in eligible patients could have a considerable impact on the total cost of health-care.
Jane Chang, Jordan Theriault, Jayashri Sankaranarayanan*, Nicholas Tessier
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