Hospitals That Report Severe Sepsis and Septic Shock Bundle Compliance Have More Structured Sepsis Performance Improvement.
Hospitals That Report Severe Sepsis and Septic Shock Bundle Compliance Have More Structured Sepsis Performance Improvement.
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DOI：
10.1097/pts.0000000000001062
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发表时间：
2022-12-01
影响因子：
2.2
通讯作者：
Ahmed, Azeemuddin
中科院分区：
文献类型：
--
作者：
Bolte, Ty B. B.;Swanson, Morgan B. B.;Kaldjian, Anna M. M.;Mohr, Nicholas M. M.;McDanel, Jennifer;Ahmed, Azeemuddin
败血症是一种常见的死亡原因。CMS SEP-1捆绑包专注于改善脓毒症结局，但尚不清楚哪些质量改进(QI)实践与SEP-1依从性和降低脓毒症死亡率有关。本研究的目的是比较SEP-1报告医院和非报告医院的败血症QI实践，并衡量脓毒症QI过程、SEP-1表现和脓毒症死亡率之间的关系。这项研究将爱荷华州医院QI实践的调查数据与SEP-1表现数据和死亡率联系起来。通过SEP-1报告状态比较医院和败血症QI实践的特点。单变量和多变量Logistic回归和线性回归估计了QI实践与SEP-1表现和观察到的与预期的脓毒症死亡率之间的关联。爱荷华州118家医院100%完成了调查。SEP-1报告的医院更有可能有败血症QI实践，包括向提供者报告败血症质量(%比38%，p=0.026)，以及使用病例审查程序制定败血症护理计划(87%比%，p=0.013)。脓毒症QI实践与SEP-1评分的增加无关。败血症登记与处于败血症死亡率底部四分之一的几率降低相关(OR：0.37；95%CI为0.14-0.96，p=0.041)，而败血症委员会的存在与较低的医院特定死亡率相关(O：E比：−0.11；95%CI−为0.20-0.01)。报告符合SEP-1的医院进行更多的败血症QI实践。大多数QI实践与SEP-1表现的提高或脓毒症死亡率的降低无关。未来的工作可以探索如何在没有报告SEP-1遵从性的医院实施这些绩效改进实践。
Sepsis is a common cause of death. The CMS SEP-1 bundle is focused on improving sepsis outcomes, but it is unknown which quality improvement (QI) practices are associated with SEP-1 compliance and reduced sepsis mortality. The objectives of this study were to compare sepsis QI practices in SEP-1 reporting and non-reporting hospitals, and to measure the association between sepsis QI processes, SEP-1 performance, and sepsis mortality. This study linked survey data on QI practices from Iowa hospitals to SEP-1 performance data and mortality. Characteristics of hospitals and sepsis QI practices were compared by SEP-1 reporting status. Univariable and multivariable logistic and linear regression estimated the association of QI practices with SEP-1 performance and observed-to-expected sepsis mortality ratios. 100% of Iowa’s 118 hospitals completed the survey. SEP-1 reporting hospitals were more likely to have sepsis QI practices, including reporting sepsis quality to providers (64% vs. 38%, p=0.026) and using the case review process to develop sepsis care plans (87% vs. 64%, p=0.013). Sepsis QI practices were not associated with increased SEP-1 scores. A sepsis registry was associated with decreased odds of being in the bottom quartile of sepsis mortality (OR: 0.37; 95%CI 0.14–0.96, p=0.041), and presence of a sepsis committee was associated with lower hospital-specific mortality (O:E ratio: −0.11; 95%CI −0.20--0.01). Hospitals reporting SEP-1 compliance conduct more sepsis QI practices. Most QI practices are not associated with increased SEP-1 performance or decreased sepsis mortality. Future work could explore how to implement these performance improvement practices in hospitals not reporting SEP-1 compliance.