Evaluating National Sepsis Policy Using the Electronic Health Record

项目概要/摘要 脓毒症是一种以感染导致危及生命的器官衰竭为特征的危重病综合征。影响 在美国，每年有超过200，000人，败血症占所有医院死亡人数的近一半 美国每年的医疗费用超过200亿美元。尽管开发和传播了基于证据的 指南，大多数脓毒症患者没有持续接受推荐的治疗，导致可预防的 发病率和死亡率。因此，人们越来越关心执行旨在 鼓励医院层面的质量改进。迄今为止，这些政策中规模最大、最突出的 是新的医疗保险和医疗补助服务中心（CMS）质量报告计划，称为SEP-1。 SEP-1要求医院报告其对各种循证护理流程的遵守情况，包括 及时给予抗生素，及时进行容量复苏，并对临床反应进行常规监测， 疗法SEP-1是CMS住院患者质量报告程序中唯一的质量措施， 因为它是唯一基于危重病综合征的衡量标准， 复杂性，需要多个医疗保健提供者在急性护理范围内的协调努力。 因此，了解SEP-1如何影响患者护理和临床结局至关重要。到 为了满足这一需求，我们建议使用 电子健康记录（EHR）是一个大型多医院医疗系统。基于EHR的方法将使我们能够 非常详细地了解政策的影响，不仅为政策制定者提供可操作的数据， 寻求改进SEP-1，但也为卫生系统寻求以最大限度地提高 潜在的好处。首先，我们将分析该计划对脓毒症识别和记录的影响 使用临床笔记的自然语言处理。其次，我们将分析该计划对 使用诸如生命体征、实验室值和药物的结构化数据元素的脓毒症护理过程 局第三，我们将评估该计划对患者死亡率、住院时间和 需要器官支持。在所有目标中，我们将检查总体效果和医院特异性效果， 了解医院和卫生系统如何在这种情况下实施质量改进 一个新的报道任务。总之，这些目标将产生重要的新的见解，如何临床医生和 医院实施新的质量报告计划。与此同时，通过一个结构化的计划， 指导，职业发展和利益相关者的参与，这个项目将提供主要的 研究人员在使用EHR的新技能，以评估医疗质量和系统级的影响 卫生政策，独特定位他领导未来的努力，制定，实施，评估和传播 基于EHR的危重患者绩效干预。

Project Summary/Abstract Sepsis is a critical illness syndrome characterized by infection leading to life-threatening organ failure. Affecting over 200,000 individuals in the United States each year, sepsis accounts for nearly half of all hospital deaths and over $20 billion in yearly US hospital costs. Despite the development and dissemination of evidence-based guidelines, most patients with sepsis do not consistently receive recommended care, resulting in preventable morbidity and mortality. Consequently, there is increasing interest in implementing health policies designed to incentivize quality improvement at the hospital level. The largest and most prominent of these policies to date is the new Centers for Medicare and Medicaid Services (CMS) quality reporting initiative, known as SEP-1. SEP-1 requires hospitals to report their compliance with a variety of evidence-based care processes, including timely antibiotic administration, timely volume resuscitation, and routine monitoring of the clinical response to therapy. SEP-1 is unique among quality measures in the CMS Inpatient Quality Reporting Program, both because it is the only measure based on a critical illness syndrome and because it is of unparalleled complexity, requiring the coordinated efforts of multiple health care providers across the acute care spectrum. As a consequence, it is essential to understand how SEP-1 has affected patient care and clinical outcomes. To address this need, we propose to comprehensively evaluate the impact of the SEP-1 measure using the electronic health record (EHR) of a large multihospital health system. An EHR-based approach will allow us to understand the impact of the policy in exceptional detail, yielding actionable data not only for policy makers seeking to refine SEP-1 but also for health systems seeking to respond to SEP-1 in a way that maximizes the potential benefits. First, we will analyze the impact of the program on sepsis recognition and documentation using natural language processing of clinical notes. Second, we will analyze the impact of the program on sepsis care processes using structured data elements such as vital signs, laboratory values, and medication administration. Third, we will evaluate the impact of the program on patient mortality, length of stay, and requirement for organ support. In all aims we will examine both overall effects and hospital-specific effects, providing an understanding of how hospitals and health systems implement quality improvement in the context of a novel reporting mandate. Together, these aims will yield important new insights into how clinicians and hospitals implement new quality reporting programs. At the same time, through a program of structured mentorship, career development, and stakeholder involvement, this project will provide the principal investigator with new skills in the use of the EHR to evaluate health care quality and the impact of system-level health policies, uniquely positioning him to lead future efforts to develop, implement, evaluate, and disseminate EHR-based performance interventions for critically ill patients.