Context Although distributed cardiopulmonary resuscitation (CPR) practice has been shown to improve learning outcomes, little is known about the cost-effectiveness of this training strategy. This study assesses the cost-effectiveness of workplace-based distributed CPR practice with real-time feedback when compared with conventional annual CPR training.
Methods We measured educational resource use, costs, and outcomes of both conventional training and distributed training groups in a prospective-randomised trial conducted with paediatric acute care providers over 12 months. Costs were calculated and reported from the perspective of the health institution. Incremental costs and effectiveness of distributed CPR training relative to conventional training were presented. Cost-effectiveness was expressed as an incremental cost-effectiveness ratio (ICER) if appropriate. One-way sensitivity analyses and probabilistic sensitivity analysis were conducted.
Results A total of 87 of 101 enrolled participants completed the training (46/53 in intervention and 41/48 in the control). Compared with conventional training, the distributed CPR training group had a higher proportion of participants achieving CPR excellence, defined as over 90% guideline compliant for chest compression depth, rate and recoil (control: 0.146 (6/41) vs intervention 0.543 (25/46), incremental effectiveness: +0.397) with decreased costs (control: $C266.50 vs intervention $C224.88 per trainee, incremental costs: −$C41.62). The sensitivity analysis showed that when the institution does not pay for the training time, distributed CPR training results in an ICER of $C147.05 per extra excellent CPR provider.
Conclusion Workplace-based distributed CPR training with real-time feedback resulted in improved CPR quality by paediatric healthcare providers and decreased training costs, when training time is paid by the institution. If the institution does not pay for training time, implementing distributed training resulted in better CPR quality and increased costs, compared with conventional training. These findings contribute further evidence to the decision-making processes as to whether institutions/programmes should financially adopt these training programmes.
- Cardiopulmonary resuscitation
- education and evaluation
- healthcare costs
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Contributors YL conceptualised and designed the study, participated in data collection, conducted the statistical analysis and interpretation of data, drafted the initial manuscript, and approved the final manuscript as submitted. KH conceptualised and designed the study, supervised the data analyses, revised the manuscript critically for intellectual content, and approved the final manuscript as submitted. AC conceptualised and designed the study, revised the manuscript critically for intellectual content, and approved the final manuscript as submitted. VJG conceptualised and designed the study, revised the manuscript critically for intellectual content, and approved the final manuscript as submitted. GC conceptualised and designed the study, provide support and expertise on economic evaluation, revised the manuscript critically for intellectual content, and approved the final manuscript as submitted.
Funding This study was funded by: (1) Laerdal Foundation for Acute Medicine Research Project Grant (2985); (2) Royal College of Physicians and Surgeons of Canada Medical Education Research Grant (15/MERG-01); and (3) University of Calgary—The Department of Pediatrics Innovation Award (N/A).
Competing interests None declared.
Provenance and peer review Not commissioned; externally peer reviewed.
Data availability statement Data are available upon reasonable request.
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