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Abstract Objective:To evaluate the economic costs of reducing the University of Virginia Hospital’s present “3-negative” policy, which continues methicillin-resistantStaphylococcus aureus(MRSA) contact precautions until patients receive 3 consecutive negative test results, to either 2 or 1 negative. Design:Cost-effective analysis. Settings:The University of Virginia Hospital. Patients:The study included data from 41,216 patients from 2015 to 2019. Methods:We developed a model for MRSA transmission in the University of Virginia Hospital, accounting for both environmental contamination and interactions between patients and providers, which were derived from electronic health record (EHR) data. The model was fit to MRSA incidence over the study period under the current 3-negative clearance policy. A counterfactual simulation was used to estimate outcomes and costs for 2- and 1-negative policies compared with the current 3-negative policy. Results:Our findings suggest that 2-negative and 1-negative policies would have led to 6 (95% CI, −30 to 44;P< .001) and 17 (95% CI, −23 to 59; −10.1% to 25.8%;P< .001) more MRSA cases, respectively, at the hospital over the study period. Overall, the 1-negative policy has statistically significantly lower costs ($628,452; 95% CI, $513,592–$752,148) annually (P< .001) in US dollars, inflation-adjusted for 2023) than the 2-negative policy ($687,946; 95% CI, $562,522–$812,662) and 3-negative ($702,823; 95% CI, $577,277–$846,605). Conclusions:A single negative MRSA nares PCR test may provide sufficient evidence to discontinue MRSA contact precautions, and it may be the most cost-effective option.
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Policy collision: a framework to identify where polycentric, multi-objective sustainability solutions are needed
Abstract The exploitation of ecosystem services, through processes like agricultural production, is associated with myriad negative environmental impacts, which are felt by stakeholders on local, regional, and global scales. The varying type and scale of impacts leads naturally to fragmented and siloed approaches to mitigating externalities by diverse governmental and non-governmental institutions. However, policies designed to address a single impact may worsen other negative impacts. As a result, even when groups have the expertise to design policy solutions in one dimension, policies addressing single issues may conflict and result in less than ideal outcomes in combination. In this paper, we present a conceptual framework and examples of this kind of ‘policy collision,’ where policies produce mutual negative interference so that policies designed independently may fail to achieve their goals. We argue that an integrated systems perspective is needed to overcome this problem and present several positive examples where this has been put into practice. Policy collision provides a useful framework for determining how each colliding policy should be modified in improve outcomes.
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- PAR ID:
- 10392755
- Publisher / Repository:
- IOP Publishing
- Date Published:
- Journal Name:
- Environmental Research Letters
- Volume:
- 18
- Issue:
- 2
- ISSN:
- 1748-9326
- Page Range / eLocation ID:
- Article No. 025004
- Format(s):
- Medium: X
- Sponsoring Org:
- National Science Foundation
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