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Cost Savings From a Policy to Diagnose and Prevent Transmission of Adenoviral Conjunctivitis in Employees of a Large Academic Medical Center

Educational Objective
To examine the institutional cost savings of a policy to diagnose adenoviral conjunctivitis and triage and furlough medical center employees with this condition to prevent outbreaks.
1 Credit CME
Key Points

Question  What is the economic impact of a quality improvement policy to diagnose suspected adenoviral conjunctivitis in medical center employees using polymerase chain reaction (PCR) before furlough?

Findings  In this quality improvement study, a total of 1520 employees underwent conjunctival swabbing for PCR for clinical suspicion of adenoviral conjunctivitis; 130 (8.6%) had positive PCR test results and required a 1- to 2-week furlough. The estimated cost savings from furloughing 130 employees instead of 1520 was more than $3 million during 7 years.

Meaning  These findings suggest that use of accurate diagnostic testing for adenoviral conjunctivitis can result in cost savings from fewer employee furloughs compared with furloughs based on clinical diagnosis, the typical method of diagnosing conjunctivitis.

Abstract

Importance  Adenoviral conjunctivitis is highly contagious, can be associated with systemic infections, and can cause chronic visual impairment. It accounts for a large proportion of acute conjunctivitis. Outbreaks of epidemic keratoconjunctivitis (EKC) are costly in terms of productivity loss from work furloughs and spread to patients and have resulted in clinic and departmental closures.

Objective  To examine the institutional cost savings of a policy to diagnose adenoviral conjunctivitis and triage and furlough medical center employees with this condition to prevent outbreaks.

Design, Setting, and Participants  This quality improvement study assessed Johns Hopkins Medicine employees with red eye from November 1, 2011, through October 31, 2018, who were triaged at the occupational health clinic whose conditions were diagnosed using polymerase chain reaction (PCR) validated for adenoviral conjunctivitis.

Interventions  Only employees with positive PCR test results were furloughed, with furlough length tailored to subtype (a minimum of 2 weeks for EKC and 1 week otherwise).

Main Outcomes and Measures  Total number of furloughs avoided and cost savings associated with reducing unnecessary furloughs.

Results  Of 2142 employees with red eye, 1520 (71.0%) underwent PCR testing; 130 (8.6%) had positive adenoviral PCR test results, of whom 41 (31.5%) had EKC. Furloughing 130 employees with positive PCR test results vs furloughing all 1520 employees clinically suspected of having adenoviral conjunctivitis represented an estimated annual savings of $442 073, or $3 094 511 during 7 years. The cost of performing PCR on employees suspected of having adenoviral conjunctivitis was 5.0% of the cost associated with furloughing all employees with red eye. No outbreaks occurred.

Conclusions and Relevance  In this quality improvement study, this policy, notable for development and use of PCR for adenoviral conjunctivitis on a large scale, resulted in substantial cost savings from fewer work furloughs compared with the number of employees who would have been furloughed based on clinical diagnosis. These results may provide impetus for policy adoption by other institutions and for development of a rapid, sensitive, and specific diagnostic test for adenoviral conjunctivitis.

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Article Information

Accepted for Publication: January 11, 2021.

Published Online: April 1, 2021. doi:10.1001/jamaophthalmol.2021.0150

Corresponding Author: Irene C. Kuo, MD, Wilmer Eye Institute, Department of Ophthalmology, Johns Hopkins University School of Medicine, 4924 Campbell Blvd, Ste 100, Baltimore, MD 21236 (ickuo@jhmi.edu).

Author Contributions: Dr Kuo had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Concept and design: Kuo.

Acquisition, analysis, or interpretation of data: All authors.

Drafting of the manuscript: All authors.

Critical revision of the manuscript for important intellectual content: All authors.

Statistical analysis: All authors.

Administrative, technical, or material support: Kuo.

Supervision: Kuo.

Conflict of Interest Disclosures: None reported.

Additional Contributions: Colleen Espinosa, CRNP, Minnie Sanders, CRNP, and other nurse practitioners in the Division of Occupational and Environmental Medicine, Johns Hopkins University School of Medicine, implemented the red eye policy, and Michael Forman, MS, Department of Pathology, Division of Medical Microbiology, Johns Hopkins University School of Medicine, performed all polymerase chain reaction testing. All these individuals are salaried employees and were not additionally compensated for this work.

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