Sepsis Survivors' Post-Acute Outcomes: Impact of Early Home Health and MD Visits

 描述（由申请人提供）：在美国，每年有超过100万名危及生命的脓毒症幸存者从急性护理医院出院。这些人的再入院率、功能下降率和死亡率很高。在大约30%的 败血症幸存者出院到熟练的家庭保健，我们发现在初步研究中30天再入院率为27%（29%发生在7天内）。脓毒症幸存者所造成的持久的身体和精神后果要求改善护理协调，早期和频繁的随访，并及时获得医疗服务。家庭护理机构提供或促进所有这些干预措施。然而，尽管人们对脓毒症的长期后果的认识有所提高，但脓毒症治疗指南中推荐的急性期后护理仍然没有得到解决，几乎没有经验证据来指导临床医生或政策制定者。这项拟议的研究将填补这一空白，检查在同一团队进行的心力衰竭患者早期研究中效果良好的干预措施是否会降低脓毒症幸存者出院到家庭医疗保健的30天全因再入院和再入院天数的概率。我们将利用大型国家医疗保险受益人数据集中发现的临床实践变化，使用创新的数据科学工具变量方法进行务实的比较有效性研究（CER）研究。我们还将通过检查与以患者为中心的功能变化、卫生保健资源利用和死亡率结局相关的因素，来解决脓毒症幸存者出院后数据缺乏的问题。实现改善脓毒症幸存者生活质量的总体目标的具体目标是：目标1。比较早期和强化家庭健康护理访视以及脓毒症幸存者的早期医生随访对30天全因再入院概率和再入院天数的影响，以及未接受这些早期干预的患者的结局。目标2。确定患者、索引医院和家庭卫生机构特征在多大程度上改变了早期干预对再入院概率和再入院天数的影响。目标3。描述并确定患者因素，索引医院和家庭健康机构的做法，以及提供者的特点与其他以患者为中心的结果后，索引留出院。我们早期项目的数据库开发软件以及我们实施严格的最先进CER方法的经验将大大减少进行拟议研究所需的时间和资源。因此，现在是时候利用现有的国家数据，并使用复杂的大数据比较有效性方法，以寻求坚实，实用的证据，有助于改善脓毒症幸存者以患者为中心的急性护理后结果。如果有效，这些普遍可用的社区干预措施的影响可能很大，每年影响超过25万医疗保险受益人的生活质量。

 DESCRIPTION (provided by applicant): Over 1 million survivors of life-threatening sepsis are discharged from acute care hospitals annually in the U.S. These individuals experience high rates of readmission, functional decline and mortality. Among the roughly 30% of sepsis survivors discharged to skilled home health care, we found in preliminary research a 30- day readmission rate of 27% (29% occurred within 7 days). The enduring physical and mental consequences incurred by sepsis survivors call for improved coordination of care, early and frequent follow-up, and timely access to medical providers. Home care agencies provide or facilitate all of these interventions. Yet, despite increased awareness of the long-term consequences of sepsis, recommended post-acute care remains unaddressed in sepsis treatment guidelines with little empirical evidence to guide clinicians or policy makers. The proposed study will fill this gap by examining whether interventions that worked so well in an earlier study of heart failure patients, conducted by the same team, will decrease the probability of 30-day all-cause readmission and readmission days for sepsis survivors discharged to home health care. We will exploit variation in clinical practice found in large national Medicare beneficiary datasets to conduct a pragmatic comparative effectiveness research (CER) study using an innovative, data science, instrumental variables approach. We also will address the dearth of post-discharge data on sepsis survivors by examining the factors associated with the patient-centered outcomes of change in function, health care resource utilization, and mortality. The specific aims to achieve the overall goal of improving the quality of life of sepsis survivors are: Aim #1. Compare the impact of early and intensive home health nursing visits and early physician follow-up for sepsis survivors on the probability of 30-day all-cause readmission and number of readmission days, to the outcomes of patients not receiving these early interventions. Aim #2. Identify the extent to which patient, index hospital and home health agency characteristics modify the effect of the early interventions on the probability of readmission and number of readmission days. Aim #3. Describe and identify the patient factors, index hospital and home-health agency practices, and provider characteristics associated with other patient-centered outcomes following index stay discharge. Database development software from our earlier project as well as our experience implementing rigorous state-of-the-art CER methods will substantially reduce the time and resources needed to conduct the proposed study. Thus, the time is ripe to harness available national data and use sophisticated big data comparative effectiveness methods in pursuit of solid, practical evidence that can contribute to improving the patient-centered post-acute-care outcomes of sepsis survivors. If effective, the impact of these commonly available, community-based interventions could be large, impacting the quality of life of over a quarter of a million Medicare beneficiaries per year.