The results of threshold effect analysis.

BackgroundAcute kidney injury (AKI) is associated with high mortality rates and long-term adverse outcomes and significantly increases medical costs. The AKI electronic alert system built the AKI diagnostic algorithm into the medical system, along with automated collection of key indications and generation of alerts. However, the relationship between the AKI electronic alert system and medical costs is still unknown.MethodsAn exploratory secondary analysis of data from a double-blinded, multicenter, parallel, randomized controlled trial to investigate the association between the AKI electronic alert system and medical costs.ResultsFinally, a total of 6030 patients were enrolled in this study. Multivariate logistic regression analysis revealed that the alert group was not significantly associated with medical costs (all p-values > 0.05). However, the rate of alert detection by an attending physician demonstrated a notable negative correlation with medical costs; adjusted effects for direct and total costs were −126.78$ and −236.82$, respectively. The curve fitting and threshold effect analysis revealed that when the rate of alert detection by an attending physician was between 18% and 59%, each unit increase in the rate corresponded to decreases in direct cost by 363.94 (−463.34, −264.55) $ and in total cost by 698.93 (−885.78, −512.07) $. Our subgroup analysis also found a significant relationship between the rate and medical costs.ConclusionThe alert group did not significantly reduce medical costs compared to the usual care group. However, the rate of alert detection by an attending physician had a significant negative association with medical costs, and there was a threshold effect between them. When the rate was between 18% and 59%, medical costs decreased as the rate increased, and when the rate was急性肾损伤（Acute kidney injury, AKI）与高死亡率及长期不良预后密切相关，且会显著增加医疗成本。当前已构建的AKI电子预警系统将AKI诊断算法嵌入医疗系统，可自动化采集关键临床指征并生成预警信息，但该系统与医疗成本之间的关联仍不明确。方法：本研究对一项双盲、多中心、平行组随机对照试验（randomized controlled trial, RCT）的数据开展探索性二次分析，以探讨AKI电子预警系统与医疗成本的关联。结果：最终共有6030例患者纳入本研究。多因素logistic回归分析显示，预警组与医疗成本无显著关联（所有P值均>0.05）。然而，主治医师的警报检出率与医疗成本呈显著负相关；直接成本与总成本的调整后效应分别为-126.78美元和-236.82美元。曲线拟合与阈值效应分析结果表明，当主治医师的警报检出率处于18%~59%区间时，检出率每提升1个单位，直接成本将降低363.94（95%置信区间：-463.34，-264.55）美元，总成本将降低698.93（95%置信区间：-885.78，-512.07）美元。本研究的亚组分析同样发现，警报检出率与医疗成本间存在显著关联。结论：与常规护理组相比，预警组并未显著降低医疗成本。但主治医师的警报检出率与医疗成本呈显著负相关，且二者间存在阈值效应。当检出率处于18%~59%区间时，医疗成本随检出率升高而降低，当检出率