Patient safety and outcomes in sepsis

描述（由申请人提供）：脓毒症是美国第10大死亡原因，占住院人数的1/50以上。脓毒症的发病率和严重程度都在增加，而且与极高的住院死亡率、幸存者死亡风险增加以及医疗资源的大量使用有关。目前的指南侧重于通过基于方案的干预措施改善脓毒症护理的提供和质量，旨在改善死亡率，降低并发症发生率，降低医疗保健利用率和成本。虽然初步研究表明，危重患者容易发生医源性不良事件，但没有研究确定全国脓毒症患者的患者安全性和结局之间的关联。通过利用医疗保健成本和利用项目国家住院患者样本中的可用数据并评估医疗保健研究和质量机构的患者安全指标（PSI），拟议的研究将在国家层面上提供患者安全性与脓毒症结局之间关联的新见解。首先，该研究将通过评估PSI事件的发生率来确定脓毒症患者并发症的发生率，并确定脓毒症患者与普通医院人群相比是否风险增加。其次，将通过多变量病例匹配技术描述与PSI事件相关的超额死亡率、住院时间和住院费用。最后，它将通过使用分层统计模型来评估医院水平的患者安全性指标是否与脓毒症结局相关。 公共卫生相关性：脓毒症是美国第十大死亡原因，与极高的住院死亡率、幸存者死亡风险增加以及医疗资源的大量使用相关。评估脓毒症患者的患者安全性措施可以突出当前护理的潜在不足之处。此外，它们可用于提高脓毒症护理的质量和提供。

DESCRIPTION (provided by applicant): Sepsis is the 10th leading cause of death in the United States and accounts for more than 1 in 50 hospitalizations. Increasing in both incidence and severity, sepsis is also associated with extremely high in-hospital mortality rates, increased risks of death among survivors, and considerable use of healthcare resources. Current guidelines focus on improving the delivery and quality of sepsis care through protocol-based interventions aimed at improving mortality, decreasing complication rates, and reducing healthcare utilization and cost. While preliminary studies suggest that critically ill patients are vulnerable to iatrogenic adverse events, no studies have defined the association of patient safety and outcomes in sepsis patients nationally. By utilizing data available in the Healthcare Cost and Utilization Project National Inpatient Sample and evaluating the Agency for Healthcare Research and Quality's Patient Safety Indicators (PSI), the proposed study will provide novel insight into the association between patient safety and sepsis outcomes on a national level. First, the study will define the incidence of complications among patients with sepsis by evaluating the rate of PSI events and determine whether sepsis patients are at increased risk compared with the general hospital population. Second, it will describe the excess mortality, length of stay, and hospital cost associated with PSI events by multivariable case matching techniques. Finally, it will evaluate whether hospital-level measures of patient safety are associated with sepsis outcomes by using hierarchical statistical models. PUBLIC HEALTH RELEVANCE: Sepsis is the 10th leading cause of death in the United States and is associated with extremely high in-hospital mortality, increased risks of death among survivors, and considerable use of healthcare resources. Evaluating measures of patient safety in patients with sepsis can highlight potential areas of deficiency in current care. Moreover, they can be used to enhance the quality and delivery of sepsis care.