Effect of a Multicomponent Sepsis Transition and Recovery Program on Mortality and Readmissions After Sepsis: The Improving Morbidity During Post-Acute Care Transitions for Sepsis Randomized Clinical Trial.
Effect of a Multicomponent Sepsis Transition and Recovery Program on Mortality and Readmissions After Sepsis: The Improving Morbidity During Post-Acute Care Transitions for Sepsis Randomized Clinical Trial.
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DOI：
10.1097/ccm.0000000000005300
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发表时间：
2022-03-01
影响因子：
8.8
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中科院分区：
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评估护士导航员引导的多组分脓毒症过渡和恢复计划是否改善脓毒症住院后30天死亡率和再入院结局。多中心实用随机临床试验。2019年1月至2020年3月，北卡罗来纳州的三家医院。符合条件的患者因疑似脓毒症住院，并通过经验证的内部风险模型被认为具有死亡或再入院的高风险。患者随机接受单独的常规护理（即，常规过渡支持，门诊护理; n = 342）或额外的脓毒症过渡和恢复支持（n = 349）。为期30天的干预包括由护士导航员通过电话和电子健康记录通信领导的多组分过渡服务，以促进住院期间和住院后的最佳实践脓毒症后护理策略，包括：出院后药物审查，评估新的损伤或症状，监测合并症，以及适当时的姑息治疗方法。临床监督由医院医学过渡服务团队提供。主要结局是30天时的死亡率或再次入院的复合终点。构建Logistic回归模型以评估边际和条件优势比（校正预后协变量：入组时的年龄、合并症和器官功能障碍）。在691例随机化患者中（平均年龄= 63.7 ± 15.1岁; 52%为女性），与常规治疗组相比，脓毒症过渡和恢复组中经历主要结局的患者百分比较低（28.7% vs 33.3%;风险差，4.7%;比值比，0.80; 95% CI，0.58-1.11;校正比值比，0.80; 95% CI，0.64-0.98）。有74例死亡（脓毒症过渡和恢复：33例[9.5%] vs常规治疗：41例[12.0%]）和155例再住院（脓毒症过渡和恢复：71例[20.3%] vs常规治疗：84例[24.6%]）。在脓毒症住院患者的多中心随机临床试验中，使用护士导航员提供脓毒症后护理最佳实践的30天计划的患者在出院后30天内的死亡率或再住院率较低。需要进一步研究，以了解与成功实施相关的背景因素。
To evaluate whether a nurse navigator-led, multicomponent Sepsis Transition And Recovery program improves 30-day mortality and readmission outcomes after sepsis hospitalization. Multisite pragmatic randomized clinical trial. Three hospitals in North Carolina from January 2019 to March 2020. Eligible patients hospitalized for suspected sepsis and deemed high-risk for mortality or readmission by validated internal risk models. Patients were randomized to receive usual care alone (i.e., routine transition support, outpatient care; n = 342) or additional Sepsis Transition And Recovery support (n = 349). The 30-day intervention involved a multicomponent transition service led by a nurse navigator through telephone and electronic health record communication to facilitate best practice postsepsis care strategies during and after hospitalization including: postdischarge medication review, evaluation for new impairments or symptoms, monitoring comorbidities, and palliative care approach when appropriate. Clinical oversight was provided by a Hospital Medicine Transition Services team. The primary outcome was a composite of mortality or hospital readmission at 30 days. Logistic regression models were constructed to evaluate marginal and conditional odds ratios (adjusted for prognostic covariates: age, comorbidity, and organ dysfunction at enrollment). Among 691 randomized patients (mean age = 63.7 ± 15.1 yr; 52% female), a lower percentage of patients in the Sepsis Transition And Recovery group experienced the primary outcome compared with the usual care group (28.7% vs 33.3%; risk difference, 4.7%; odds ratio, 0.80; 95% Cl, 0.58–1.11; adjusted odds ratio, 0.80; 95% Cl, 0.64–0.98). There were 74 deaths (Sepsis Transition And Recovery: 33 [9.5%] vs usual care: 41 [12.0%]) and 155 rehospitalizations (Sepsis Transition And Recovery: 71 [20.3%] vs usual care: 84 [24.6%]). In a multisite randomized clinical trial of patients hospitalized with sepsis, patients provided with a 30-day program using a nurse navigator to provide best practices for postsepsis care experienced a lower proportion of either mortality or rehospitalization within 30 days after discharge. Further research is needed to understand the contextual factors associated with successful implementation.