I-TRANSFER Improving TRansitions ANd outcomeS oF sEpsis suRvivors

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Sepsis is a life-threatening disease characterized by acute organ dysfunction and dysregulated immune response secondary to infection. Compared to other illnesses, 30-day hospital readmission rates after sepsis are consistently high, ranging from 17% to 35%. Among readmitted home health sepsis survivors, 32% occurred within the first 7 days. Our work demonstrated that 30-day readmission rates are 7 percentage points lower in sepsis survivors who receive a protocol that includes both timely home health (HH) and outpatient care. Notably, only 28% of 170,500 sepsis survivors nationally received this protocol. Our current NINR funded implementation science study, I-TRANSFER (R01NR016014) is implementing this protocol. This supplement will broaden our understanding of the mechanisms of action (MOA) behind protocol- adherence behaviors from the patients' and caregivers' perspectives and increase our knowledge of how to facilitate behavior toward initiation and adoption of timely HH and outpatient care. The Common-sense Model of Self-regulation of Health and Illness (CS-SRM) will guide our exploration of MOA that relate to patient and caregiver perceptions of sepsis and rationale toward timely HH and outpatient visits. The model posits that coping strategies, such as seeking medical attention, are formed through the cognitive and emotional illness representations in eight dimensions based on situational stimuli, e.g., symptoms and knowledge. Aim 1. Quantitatively compare patient illness representations of sepsis (e.g., consequences, personal control, identity, concern, understanding) among two groups of sepsis survivors: those with and without full protocol adherence; controlling for social determinants of health (SDH). Aim 2. Qualitatively explore similarities and differences in CS-SRM dimensions with patients and their caregivers from the two protocol groups, as well as alternative behavior-related factors (e.g., SDH, transportation, outpatient visit copays) contributing to timely HH and outpatient care. Patient and caregiver illness perceptions have never been studied in the sepsis population, nor to promote these important interventions. The results of the proposed study will inform intervention adherence and will support a future grant proposal to develop and test a patient and caregiver intervention to improve decision-making behaviors related to acceptance of post-acute treatment. This application meets the specific requests of NOT-OD-23-083.