Building Learning Health System Capacity: Leveraging Lessons from an Evaluation of a SEPSIS Clinical Decision Support Tool

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Project Summary Sepsis is a clinical syndrome defined as a life-threatening organ dysfunction caused by a dysregulated host response to infection. There is significant burden associated with sepsis, with over 1.7 million adult cases diagnosed annually in the U.S., which in turn contribute to 270,000 deaths. These clinical challenges are mirrored in the cost of treating sepsis, which ranks highest among all conditions in U.S. hospitals and represents 13% of all hospital costs while accounting for only 3.6% of all hospital stays. A fundamental challenge to diagnosing and treating sepsis, and thus reducing its cost and quality burden, is that there is no confirmatory diagnostic test. Rather the diagnosis of sepsis requires clinical judgment based on evidence of infection and organ dysfunction provided from multiple sources, including microbiology, medication administration, laboratory, and administrative/coding data. One approach to overcome these challenges is to use clinical decision support systems that provide clinical knowledge and patient-related information to providers at appropriate times to enhance patient care. Yet, the application of clinical decision support systems to sepsis care is in its infancy and challenges to implementation are not well understood. The purpose of this mixed methods study is to evaluate the implementation of a clinical decision support system to understand its effect on clinical and implementation outcomes. Importantly, the implementation of the clinical decision support system occurs in the context of a larger health system initiative to become a Learning Health System, defined as an organization that continuously evaluates and adapts practices using data and analytics to generate knowledge and implement behavior change that can improve quality. Thus, the study is guided by the following aims: Aim 1: Assess fidelity to a sepsis detection and treatment program and iteratively identify adaptations required to scale up the program; Aim 2: Examine the influence of a sepsis detection and treatment program on clinical and implementation outcomes; and Aim 3: Develop a process for integrating study findings and institutionalize Learning Health System program evaluation capacity.