eprintid: 35569
rev_number: 14
userid: 7881
dir: disk0/00/03/55/69
datestamp: 2019-01-30 17:38:10
lastmod: 2019-01-30 17:38:10
status_changed: 2019-01-30 17:38:10
type: thesis_degree
metadata_visibility: show
contact_email: lilin126@hotmail.com
eprint_status: archive
creators_name: Lin, Li
creators_email: lil126@pitt.edu
creators_id: lil126
title: Improving the duration of airborne isolation for suspected pulmonary tuberculosis: cost-effectiveness analysis
ispublished: unpub
divisions: sch_gsph_infectiousdiseasesmicrobiology
full_text_status: restricted
keywords: TB; airborne isolation; discontinuation of isolation
abstract: Background: Airborne isolation (AI) is an effective way to prevent the spread of tuberculosis (TB). When healthcare facilities are faced with patients with suspected pulmonary TB, they place patients in AI and order at least 3 specimens for acid-fast bacilli (AFB) smears and culture. The specimens are collected 8-24 hours apart with at least one morning specimen. When 3 consecutive specimens are negative on smears or another diagnosis is made, AI is discontinued. However, there is a significant delay in discontinuation of AI. Effective strategies are needed to shorten the duration in AI.
Public Health Significance: Delayed deisolation is associated with significant avoidable cost for the hospitals and patients without health insurance and related with preventable negative health effects on patients over-isolated.
Aims: The objective is to evaluate current practice of AI and improve the efficiency of deisolation for patients without contagious TB.
Method: Demographic and clinical information was reviewed from Jan 2015 to Dec 2017 at a 495-bed university-affiliated medical center. Cost-effectiveness analysis was performed to compare isolation with no isolation. TreeAge Pro 2018 Software was used to build a decision tree and make a sensitivity analysis. 
Result: The positive rate of respiratory specimens is 6.3%. 93 patients had contagious TB excluded successfully with 3 consecutive negative AFB smears. AI is always cost-effective than no isolation despite the variation of its effectiveness. The average LOS in AI is 4.8 days. If LOS can be reduced to 2 days, the cost saving is $3,122 per patient. The total cost saving for 93 patients is $290,160.
Conclusion: This study shows a significant delay in deisolation for patients without contagious TB. More effective measures are needed to rule out TB timely. Improved efficiency in deisolation can contribute to a significant cost saving. Cost-effectiveness analysis will be a powerful aid to decision making that could engage hospital administration to improve the efficiency of deisolation.
date: 2019-01-30
date_type: published
pages: 49
institution: University of Pittsburgh
refereed: TRUE
etdcommittee_type: committee_chair
etdcommittee_type: committee_cochair
etdcommittee_type: committee_member
etdcommittee_name: Mattila, Joshua
etdcommittee_name: Yassin, Mohamed
etdcommittee_name: Chen, Yue
etdcommittee_email: jmattila@pitt.edu
etdcommittee_email: mhy8@pitt.edu
etdcommittee_email: cheny@pitt.edu
etdcommittee_id: jmattila
etdcommittee_id: mhy8
etdcommittee_id: cheny
etd_defense_date: 2018-11-30
etd_approval_date: 2019-01-30
etd_submission_date: 2018-11-26
etd_release_date: 2019-01-30
etd_access_restriction: 3_year
etd_patent_pending: FALSE
thesis_type: thesis
degree: MPH
citation:   Lin, Li  (2019) Improving the duration of airborne isolation for suspected pulmonary tuberculosis: cost-effectiveness analysis.  Master's Thesis, University of Pittsburgh.    (Unpublished)  
document_url: http://d-scholarship-dev.library.pitt.edu/35569/1/LinLi_MPHthesis_Dec2018%20.docx.pdf