The effects of state sepsis mandates on hospital mortality, health care utilization, and costs

摘要 脓毒症是美国发病率和死亡率的主要原因，影响超过750,000人 美国人每年花费超过200亿美元。有几种治疗方法是经过证实的。 对这一人群的有效性，包括及时给予抗生素和早期复苏 用静脉输液。然而，这些治疗方法的应用不一致，造成了一个重要的 质量差距。早期识别和治疗的方案可以帮助弥合这一差距并挽救生命 脓毒症患者，反过来，政策制定者越来越多地使用法律机制来激励 败血症方案的使用。其中一项倡议是一套史无前例的纽约州法规 于2013年6月开始实施，统称为“罗里条例”。以罗里的名字命名 在纽约一家医院死于败血症的12岁男孩Staunton，Rory的规定要求 该州所有医院都执行基于证据的脓毒症管理和报告方案 向州政府提供有关脓毒症方案遵守情况和结果的数据。罗里的规定是一种 基于政策的质量改进的创新战略，因为它们将传统的质量报告联系起来 对循证实践有具体的任务规定。他们也是领先的先行者 其他州和国家一级正在制定的败血症法规，使其势在必行 我们了解他们的临床和财务影响。这项提案的总体目标是系统性地 评估纽约州败血症法规的影响。我们计划一种新的混合方法 旨在提供信息的方法，政策制定者不仅可以使用这些信息来完善现有政策 也是为了设计和实施未来的政策。首先，我们将使用医院急诊科和 来自纽约和八个对照州的住院数据，以评估2013年法规对 死亡率、护理并发症、卫生保健利用和成本、控制病例组合和 时间趋势。其次，我们将用理论驱动的理论来补充我们的定量分析 定性分析，我们将对KEY执行和分析半结构化访谈 纽约州的利益相关者，包括临床医生、政策制定者和患者权益倡导者。这 定性分析将有助于解释总体政策效果，并提供可操作的 为寻求制定类似脓毒症相关法规的政策制定者提供指导。总而言之，这些目标 将包括对全州范围内一套里程碑式的败血症法规的第一次严格评估。更多 总的来说，它们将是对全州范围内质量改进的新战略的第一次评估，通过 对具体的循证做法的政策授权，直接指导今后改进 不仅在败血症方面，而且在医院医学的其他方面也提供高质量的护理。

ABSTRACT Sepsis is a leading cause of morbidity and mortality in the United States, affecting over 750,000 Americans each year at an annual cost of over $20 billion. Several medical treatments are of proven effectiveness in this population, including timely administration of antibiotics and early resuscitation with intravenous fluids. However these treatments are inconsistently applied, creating an important quality gap. Protocols for early recognition and treatment can help close this gap and save lives in patients with sepsis, and in turn policy makers are increasingly using legal mechanisms to incentivize the use of sepsis protocols. One such initiative is an unprecedented set of New York State regulations implemented in June of 2013 and collectively known as “Rory's Regulations”. Named after Rory Staunton, a 12-year-old boy who died of sepsis at a New York hospital, Rory's Regulations mandate that all hospitals in the state implement evidence-based protocols for sepsis management and report data on sepsis protocol adherence and outcomes to the state government. Rory's Regulations are an innovative strategy for policy-based quality improvement in that they link traditional quality reporting with specific mandates for evidence-based practice. They are also a leading-edge forerunner to sepsis regulations in development in other states and at the national level, making it imperative that we understand their clinical and financial impact. The overall goal of this proposal is to systematically evaluate the impact of the New York state sepsis regulations. We plan a novel mixed methods approach designed to yield information that policy makers can use not only to refine the existing policy but also to design and implement future polices. First, we will use hospital emergency department and inpatient data from New York and eight control states to assess the effects of the 2013 regulations on mortality, complications of care, health care utilization and costs, controlling for case-mix and temporal trends. Second, we will complement our quantitative analyses with a theory-driven qualitative analysis in which we will perform and analyze semi-structured interviews with key stakeholders in New York State, including clinicians, policy-makers, and patient advocates. This qualitative analysis will serve to help interpret the overall policy effects and provide actionable guidance to policy makers seeking to develop similar sepsis-related regulations. Together, these aims will comprise the first rigorous evaluation of a landmark set of state-wide sepsis regulations. More broadly, they will be the first evaluation of a novel strategy for state-wide quality improvement through policy mandates for specific evidence-based practices, directly informing future efforts to improve the quality of care not only in sepsis but also in other aspects of hospital medicine.