.. include:: ../variables.rst .. _roiassumptions: ROI Assumptions =============== The ROI Assumptions page is where you tune the inputs that drive the :ref:`HAI Cost-Avoidance / ROI` report and the four ROI widgets on the Executive dashboard. The defaults are seeded from published CDC, AHRQ, and peer-reviewed estimates so the report produces a defensible figure out of the box, but every facility's program cost, length-of-stay cost, readmission rate, and infection-cost numbers differ. Tuning the assumptions against your own surveillance data and finance contracting figures gives you a number you can take into a budget meeting and defend line by line. To open the ROI Assumptions page, go to :blue:`Account` | :blue:`Advanced` | :blue:`ROI Assumptions`. .. warning:: The :ref:`HAI Cost-Avoidance / ROI` report is currently a **preview feature** and is gated by a system-wide toggle. Until an operator enables the ROI / HAI preview flag in :blue:`System` | :blue:`Preview Features`, the report will not appear in the report catalog even though the ROI Assumptions editor and the dashboard ROI widgets remain visible. .. figure:: /images/lightmode/account-advanced-roi.png :align: center |br| The page is a single editor dialog organised into four sections: **Account**, **Program and Compliance**, **Length-of-Stay and Readmission**, and **HAI Categories**. The footer carries ``Reset to defaults``, ``Cancel``, and ``Save`` buttons; the sections below explain each field, what it does in the calculation, and where the published default comes from. .. note:: The defaults shipped with |APPNAME| are **illustrative starting points**, not facility-specific estimates. They are sourced from the published literature listed in :ref:`References` at the bottom of this page. Replacing them with your own surveillance figures, finance contracting, and infection-prevention program cost produces a far more credible model — and is expected. Account ------- The account dropdown at the top of the form selects which account's assumptions you are editing. System users see every account in the list and can pick any one; account administrators see their own account already selected, with the dropdown locked. Switching the dropdown reloads the form with that account's saved values; if an account has no overrides, the published defaults are shown until you save. Program and Compliance ---------------------- This section captures the inputs that turn a *compliance lift* into a *number of infections avoided*. The four fields together drive the core multiplier in the ROI model. Annual program cost ($) ^^^^^^^^^^^^^^^^^^^^^^^ The all-in cost of running |APPNAME| at this account for one year — the licence fee plus the staff time, training, and any auxiliary hardware. This figure is prorated to the report period (for example, a 90-day report uses roughly a quarter of the annual cost) and subtracted from the gross savings to give the net savings figure on the ROI report. The default is ``$75,000``, picked as a mid-range illustrative number; replace it with your own contracted licence cost plus any internal time you can attribute to running the program. Baseline compliance (%) ^^^^^^^^^^^^^^^^^^^^^^^ The hand hygiene compliance level you measure improvement against. The ROI calculation only counts compliance gains *above* this baseline; anything observed at or below the baseline produces zero avoided HAIs. The default is ``60 %``, drawn from large multi-centre hand hygiene observational studies that consistently report pre-intervention compliance in the 40–60 % range [1]_ [2]_. .. tip:: Pick a baseline that is defensible to your finance partners — a pre-program audit, a published industry average, or your own compliance from the year before |APPNAME| was deployed. A conservative baseline gives a smaller but more credible ROI number; an aggressive one looks impressive but is easy to challenge. Attributable fraction (0--1) ^^^^^^^^^^^^^^^^^^^^^^^^^^^^ The share of the relevant HAIs that improved hand hygiene can plausibly prevent. The default is ``0.40`` (40 %), in line with published estimates of the contribution of hand hygiene compliance to HAI prevention [3]_ [4]_. Lowering this number makes the model more conservative. .. note:: The WHO and several authors have used figures as high as 50 % in campaign materials, but more conservative analyses settle in the 30–40 % range. |APPNAME| ships at 40 % to land squarely in the middle of the published evidence. Patient-days per session (estimate) ^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^ |APPNAME| does not collect census feeds, so the model estimates patient days from the count of audit sessions in the period. The default multiplier is ``3.00``, meaning one audit session represents roughly three patient days of clinical activity. Tune this against your own sampling pattern if you can — if your auditors round typically two patients per session, drop the multiplier; if they walk an entire wing, raise it. Length-of-Stay and Readmission ------------------------------ When an HAI is avoided, the savings extend past the cost of the infection itself — the patient leaves the hospital sooner and is less likely to come back. The four fields in this section capture both effects. LOS days per HAI ^^^^^^^^^^^^^^^^ The average number of additional inpatient days a patient stays when they acquire an HAI, across all HAI types. Multiplied by ``LOS cost per day`` and the number of HAIs avoided to give the length-of-stay savings component of the ROI. The default is ``7.5`` days, near the midpoint of the 4–15 day range reported across HAI types in CDC and AHRQ analyses [5]_ [6]_. LOS cost per day ($) ^^^^^^^^^^^^^^^^^^^^ The dollar cost to your facility of one extra inpatient day, including bed, staffing, supplies, and overhead. The default is ``$2,200``, in line with published all-payer estimates of average US inpatient day costs [7]_. Use your own contracting or finance figure where possible — this is one of the easiest levers to defend with internal data. Readmit rate (0--1) ^^^^^^^^^^^^^^^^^^^ The fraction of HAI patients who are readmitted within the post-discharge window your facility tracks. The default is ``0.18`` (18 %), close to the all-cause 30-day Medicare readmission rate historically reported by CMS [8]_; HAI-specific readmissions are typically a few points higher again. Readmit cost ($) ^^^^^^^^^^^^^^^^ The dollar cost of one readmission. The default is ``$14,400``, based on published mean readmission costs across major HAI categories [9]_. Again, replace with your own finance figure where you have one. HAI Categories -------------- The HAI Categories table covers the five infection types responsible for the bulk of attributable HAI cost in US hospitals. Each row has an ``Include`` toggle, the cost per case, and the baseline incidence rate per 1,000 patient-days. Disable a category when your facility does not track it, or when you prefer to leave it out of the figure for credibility reasons (for example, an outpatient surgical centre might disable ``C. difficile`` and ``CAUTI``). * ``CLABSI`` — central line-associated bloodstream infection. * ``CAUTI`` — catheter-associated urinary tract infection. * ``SSI`` — surgical site infection. * ``C. difficile`` — *Clostridioides difficile* infection. * ``MRSA`` — methicillin-resistant *Staphylococcus aureus* infection. The baseline rate is expressed per 1,000 patient-days, so an entry of ``0.80`` means the model assumes an average of 0.8 CLABSI events per 1,000 patient-days of clinical activity in the absence of any hand hygiene improvement. The shipped defaults are drawn from peer-reviewed cost-of-infection work and the CDC's National Healthcare Safety Network surveillance reports: * **Cost per case** defaults are drawn from the consensus meta-analysis by Zimlichman *et al.* [9]_, which is the most widely cited single source for HAI cost in the US context and is used by AHRQ in its HAI program materials. * **Baseline incidence rates** are aligned with the CDC's NHSN Annual HAI Progress Reports [10]_, scaled to a per-1,000- patient-day basis. .. tip:: Cite your source. The defaults above come from CDC, AHRQ, and peer-reviewed estimates and are reasonable starting points, but a finance partner will respect a number that points back to your own surveillance data or a named published source. If you do override a default, jot the source down in your finance binder alongside the new figure. Saving and Resetting -------------------- * ``Save`` — writes the current form values back to the selected account. The next report run and the next dashboard refresh pick up the new figures. * ``Reset to defaults`` — clears any account-specific overrides for the selected account so that the next load falls back to the published defaults seeded at install time. The form is repopulated with those defaults immediately. * ``Cancel`` — closes the dialog without saving. .. note:: Patient-days are an estimate when no census feed is available. Where a facility provides census data, replacing the estimate with real patient-day counts produces a more accurate cost-avoidance figure. Until then, the ``Patient-days per session`` multiplier is the best lever to tune for your sampling pattern. .. _roi.references: References ---------- The published sources behind the shipped defaults are listed below. None of these are paywalled — each is freely available through the linked publisher, CDC, AHRQ, or PubMed. .. [1] Pittet D, Hugonnet S, Harbarth S, *et al.* "Effectiveness of a hospital-wide programme to improve compliance with hand hygiene." *Lancet* 2000;356(9238):1307–12. The foundational multi-year hand-hygiene improvement study — reports a pre-intervention compliance figure in the high 40 % range, climbing into the 60s after the campaign. .. [2] Erasmus V, Daha TJ, Brug H, *et al.* "Systematic review of studies on compliance with hand hygiene guidelines in hospital care." *Infection Control & Hospital Epidemiology* 2010;31(3):283–94. A 96-study systematic review; median observed compliance was 40 %. .. [3] Allegranzi B, Pittet D. "Role of hand hygiene in healthcare-associated infection prevention." *Journal of Hospital Infection* 2009;73(4):305–15. Reviews the evidence linking hand hygiene compliance to HAI rates and supports an attributable-fraction estimate in the 30–50 % range. .. [4] World Health Organization. *WHO Guidelines on Hand Hygiene in Health Care.* Geneva: WHO; 2009. The reference document for the global hand-hygiene campaign; uses an illustrative attributable fraction near 50 % in campaign materials. .. [5] Scott RD II. *The Direct Medical Costs of Healthcare-Associated Infections in U.S. Hospitals and the Benefits of Prevention.* Atlanta: Centers for Disease Control and Prevention; 2009. The CDC's foundational estimate of the per-HAI cost burden in US hospitals. .. [6] Agency for Healthcare Research and Quality. *Estimating the Additional Hospital Inpatient Cost and Mortality Associated With Selected Hospital-Acquired Conditions.* Rockville: AHRQ; 2017. Source for the typical 4–15 day excess length of stay across HAI types. .. [7] Agency for Healthcare Research and Quality. *HCUP Statistical Brief — Costs for Hospital Stays in the United States.* Most-recent annual edition. https://hcup-us.ahrq.gov/reports/statbriefs.jsp. Source for the shipped ``LOS cost per day`` default. .. [8] Centers for Medicare & Medicaid Services. *Hospital Readmissions Reduction Program* annual reports. https://www.cms.gov/medicare/quality/value-based-programs/hospital-readmissions. Source for the shipped 18 % readmission-rate default. .. [9] Zimlichman E, Henderson D, Tamir O, *et al.* "Health care-associated infections: a meta-analysis of costs and financial impact on the U.S. health care system." *JAMA Internal Medicine* 2013;173(22):2039–46. The most widely cited modern meta-analysis of US HAI cost per case; source for the shipped ``Cost per HAI`` defaults across CLABSI, CAUTI, SSI, *C. difficile*, and MRSA. .. [10] Centers for Disease Control and Prevention. *National Healthcare Safety Network (NHSN) Annual HAI Progress Report.* Atlanta: CDC; most-recent annual edition. https://www.cdc.gov/nhsn/datastat/. Source for the shipped baseline incidence rates per 1,000 patient-days.