Evaluating National Sepsis Policy Using the Electronic Health Record

项目总结/文摘

Project Summary/Abstract Sepsis is a critical illness syndrome characterized by infection leading to life-threatening organ failure. Affecting over 200,000 individuals in the United States each year, sepsis accounts for nearly half of all hospital deaths and over $20 billion in yearly US hospital costs. Despite the development and dissemination of evidence-based guidelines, most patients with sepsis do not consistently receive recommended care, resulting in preventable morbidity and mortality. Consequently, there is increasing interest in implementing health policies designed to incentivize quality improvement at the hospital level. The largest and most prominent of these policies to date is the new Centers for Medicare and Medicaid Services (CMS) quality reporting initiative, known as SEP-1. SEP-1 requires hospitals to report their compliance with a variety of evidence-based care processes, including timely antibiotic administration, timely volume resuscitation, and routine monitoring of the clinical response to therapy. SEP-1 is unique among quality measures in the CMS Inpatient Quality Reporting Program, both because it is the only measure based on a critical illness syndrome and because it is of unparalleled complexity, requiring the coordinated efforts of multiple health care providers across the acute care spectrum. As a consequence, it is essential to understand how SEP-1 has affected patient care and clinical outcomes. To address this need, we propose to comprehensively evaluate the impact of the SEP-1 measure using the electronic health record (EHR) of a large multihospital health system. An EHR-based approach will allow us to understand the impact of the policy in exceptional detail, yielding actionable data not only for policy makers seeking to refine SEP-1 but also for health systems seeking to respond to SEP-1 in a way that maximizes the potential benefits. First, we will analyze the impact of the program on sepsis recognition and documentation using natural language processing of clinical notes. Second, we will analyze the impact of the program on sepsis care processes using structured data elements such as vital signs, laboratory values, and medication administration. Third, we will evaluate the impact of the program on patient mortality, length of stay, and requirement for organ support. In all aims we will examine both overall effects and hospital-specific effects, providing an understanding of how hospitals and health systems implement quality improvement in the context of a novel reporting mandate. Together, these aims will yield important new insights into how clinicians and hospitals implement new quality reporting programs. At the same time, through a program of structured mentorship, career development, and stakeholder involvement, this project will provide the principal investigator with new skills in the use of the EHR to evaluate health care quality and the impact of system-level health policies, uniquely positioning him to lead future efforts to develop, implement, evaluate, and disseminate EHR-based performance interventions for critically ill patients.