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。这些人经历了高再住院率、功能衰退和死亡率。在大约30%的败血症幸存者中，我们在初步研究中发现，30%的败血症幸存者30天再住院率为27%(29%发生在7天内)。败血症幸存者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提供者。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增加，但脓毒症治疗指南中仍未提到推荐的急性后护理，几乎没有经验证据来指导临床医生或政策制定者。这项拟议的研究将通过检查在同一团队对心力衰竭患者进行的早期研究中如此有效的干预措施是否会减少败血症幸存者出院到家庭医疗保健中心的30天全原因再住院和再住院天数来填补这一空白。我们将利用在大型国家医疗保险受益人数据集中发现的临床实践的差异，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改变、医疗资源利用和死亡率的结果相关的因素来解决脓毒症幸存者出院后数据的匮乏问题。为实现提高败血症幸存者生活质量的总体目标的具体目标是：目的1.比较早期强化家庭健康护理访问和早期医生随访对败血症幸存者30天全原因再入院概率和再入院天数的影响，与未接受这些早期干预的患者的结果进行比较。目的#2.确定患者、医院和家庭卫生机构的特征在多大程度上改变了早期干预措施对再入院概率和再入院天数的影响。目的#3.描述和确定患者因素、指标医院和家庭健康机构的做法，以及与其他以患者为中心的指标出院后结果相关的提供者特征。我们早期项目的数据库开发软件以及我们实施最先进的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，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来寻求可靠、实用的证据，有助于改善以患者为中心的脓毒症幸存者的急性护理后结果的时机已经成熟。如果有效，这些常见的、以社区为基础的干预措施的影响可能会很大，影响到每年超过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.