Over 1 million survivors of life-threatening sepsis are discharged from acute care hospitals annually in the U.S. These individuals experience high rates of readmission, functional decline and mortality. Among the roughly 30% of sepsis survivors discharged to skilled home health care, we found in preliminary research a 30- day readmission rate of 27% (29% occurred within 7 days). The enduring physical and mental consequences incurred by sepsis survivors call for improved coordination of care, early and frequent follow-up, and timely access to medical providers. Home care agencies provide or facilitate all of these interventions. Yet, despite increased awareness of the long-term consequences of sepsis, recommended post-acute care remains unaddressed in sepsis treatment guidelines with little empirical evidence to guide clinicians or policy makers. The proposed study will fill this gap by examining whether interventions that worked so well in an earlier study of heart failure patients, conducted by the same team, will decrease the probability of 30-day all-cause readmission and readmission days for sepsis survivors discharged to home health care. We will exploit variation in clinical practice found in large national Medicare beneficiary datasets to conduct a pragmatic comparative effectiveness research (CER) study using an innovative, data science, instrumental variables approach. We also will address the dearth of post-discharge data on sepsis survivors by examining the factors associated with the patient-centered outcomes of change in function, health care resource utilization, and mortality.
The specific aims to achieve the overall goal of improving the quality of life of sepsis survivors are:
Aim #1. Compare the impact of early and intensive home health nursing visits and early physician follow-up for sepsis survivors on the probability of 30-day all-cause readmission and number of readmission days, to the outcomes of patients not receiving these early interventions.
Aim #2. Identify the extent to which patient, index hospital and home health agency characteristics modify the effect of the early interventions on the probability of readmission and number of readmission days.
Aim #3. Describe and identify the patient factors, index hospital and home-health agency practices, and provider characteristics associated with other patient-centered outcomes following index stay discharge. Database development software from our earlier project as well as our experience implementing rigorous state-of-the-art CER methods will substantially reduce the time and resources needed to conduct the proposed study. Thus, the time is ripe to harness available national data and use sophisticated big data comparative effectiveness methods in pursuit of solid, practical evidence that can contribute to improving the patient-centered post-acute-care outcomes of sepsis survivors. If effective, the impact of these commonly available, community-based interventions could be large, impacting the quality of life of over a quarter of a million Medicare beneficiaries per year.
Over a million people survive life-threatening sepsis annually but we lack evidence about effective clinical practices for addressing high rates of poor outcomes after hospital discharge. This study will use national Medicare data to examine the impact of commonly available, home health and physician interventions on the hospital readmission rate of over 250,000 sepsis survivors discharged to home health care, and to produce a longitudinal, comprehensive view of patient, hospital, home care agency and physician services and their relationship with other patient outcomes. Study results have the potential to fill a critical void in clinical guidelines and substantially improve the quality of lfe of the large and growing number of sepsis survivors.
| Meyer, Nathaniel; Harhay, Michael O; Small, Dylan S et al. (2018) Temporal Trends in Incidence, Sepsis-Related Mortality, and Hospital-Based Acute Care After Sepsis. Crit Care Med 46:354-360 |
| Riegel, Barbara; Huang, Liming; Mikkelsen, Mark E et al. (2018) Early Post-Intensive Care Syndrome among Older Adult Sepsis Survivors Receiving Home Care. J Am Geriatr Soc : |
| Dietz, Brett W; Jones, Tiffanie K; Small, Dylan S et al. (2017) The Relationship Between Index Hospitalizations, Sepsis, and Death or Transition to Hospice Care During 30-Day Hospital Readmissions. Med Care 55:362-370 |
| Maley, Jason H; Mikkelsen, Mark E (2016) Short-term Gains with Long-term Consequences: The Evolving Story of Sepsis Survivorship. Clin Chest Med 37:367-80 |
| Maley, Jason H; Brewster, Isabel; Mayoral, Iris et al. (2016) Resilience in Survivors of Critical Illness in the Context of the Survivors' Experience and Recovery. Ann Am Thorac Soc 13:1351-60 |
