Mitigating Structural Racism to Reduce Inequities in Sepsis Outcomes

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PROJECT ABSTRACT Sepsis affects approximately 1.7 million patients in the US annually, is one of the leading causes of mortality, and is a major driver of US healthcare costs. African American/Black (AA/B) and LatinX populations experience higher rates of sepsis complications, deviations from standard care, and all-cause and sepsis readmissions compared with Non-Hispanic White (NHW) populations. Despite clear evidence of the ways in which structural racism compounds factors at the hospital and community levels to generate poorer sepsis care and outcomes for AA/B and LatinX patients, there are no evidence-based, prospective interventions to name and address structural racism in sepsis care, nor are we aware of studies that report reductions in racial inequities in sepsis care as an outcome. Naming and addressing the impact of structural racism on sepsis care will require collective action across health systems and community institutions, supported by ways of working (e.g., organizational culture) to collaborate effectively across historical, political, and organizational boundaries. Our prior research has shown that coalition-based leadership development approaches can be effective in cultivating organizational culture that can improve complex health outcomes. We propose to adapt, deliver, and evaluate a coalition-based intervention to equip health systems and their surrounding communities to name and address structural racism and drive measurable reductions in inequities in sepsis outcomes. Our specific aims are to: (1) Adapt and deliver a coalition-based leadership intervention in eight U.S. health systems and their surrounding communities to improve domains of organizational culture that are required to name and address structural racism; (2) Evaluate the impact of the intervention using a longitudinal, convergent mixed methods approach to quantify change in domains of organizational culture that are required to name and address structural racism using a novel survey instrument and describe the experience of culture change within each system, integrating quantitative and qualitative data at the analysis phase in order to develop a comprehensive understanding of the intervention impact and mechanisms by which the impact may have occurred; and (3) Evaluate the impact of the intervention on reduction of racial inequities in three clinical outcomes: a) early identification (time to antibiotic), b) clinical management (in-hospital sepsis mortality) and c) standards-based follow up (same-hospital, all-cause sepsis readmissions) using interrupted time series analysis and comparing clinical outcomes from systems that achieved meaningful change in domains of culture required to address structural racism with those that did not achieve meaningful change. The proposed study is timely, highly relevant, and fully aligned with calls to action by the NIH and the Sepsis Alliance to address inequities in sepsis care and outcomes. It is also highly innovative, as it would be the first to intervene prospectively to mitigate effects of structural racism by developing the domains of organizational culture that are required for anti-racist action, with implications for inequities in complex health outcomes beyond sepsis.