Practice guideline adherence and health care outcomes--use of prophylactic antibiotics during surgery in Taiwan.
OBJECTIVE
To evaluate adherence to guidelines for prophylactic antibiotic use in total knee replacement (TKR) and total hip replacement (THR) procedures and to examine the associations between guideline adherence and health care outcomes.


METHODS
Using nationwide health insurance claims data, all adult inpatients undergoing TKR or THR procedures at teaching hospitals from 2002 to 2006, were included. Guideline adherence rates were assessed every year according to the national guidelines introduced in 2004. Multiple regression analyses with generalized estimating equations models were used to examine the relationships between the deliberate variables.


RESULTS
The guideline adherence rates stably increased from 14.07% in 2002 to 28.34% in 2006. The 2006 dataset included 12 863 observations. The results revealed that guideline adherence was negatively associated with length of stay and health care expenses with beta = -0.0207 and -0.0087, respectively (P < 0.0001). The 30-day readmission rate was 1.54% among the patients seen in 2006, and it was significantly different between the two groups, with 0.90% of the adherence group and 1.82% of the non-adherence group being readmitted (P = 0.0002).


CONCLUSIONS
The guideline adherence for prophylactic use of antibiotics is improving in Taiwan and is associated with a shorter length of stay, fewer medical expenses and lower 30-day readmission rates. Promoting evidence-based practice guidelines may be beneficial to patients and health care providers.
Hsu
Chentong
C
Institute of Health Policy & Management, College of Public Health, National Taiwan University, Taipei, Taiwan.
Cheng
Shou-Hsia
SH
D000328:Adult; D000368:Aged; D019072:Antibiotic Prophylaxis / Q000706:statistics & numerical data*; D019644:Arthroplasty, Replacement, Hip; D019645:Arthroplasty, Replacement, Knee; D016009:Chi-Square Distribution; D005260:Female; D019983:Guideline Adherence; D017722:Hospital Charges; D006784:Hospitals, Teaching; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D010359:Patient Readmission / Q000706:statistics & numerical data; D017410:Practice Guidelines as Topic; D016459:Prosthesis-Related Infections / Q000517:prevention & control*; D012044:Regression Analysis; D013624:Taiwan