Optimizing Veteran Recovery from Sepsis (OVeR-Sepsis)

背景脓毒症-由感染引发的危及生命的器官功能障碍-住院治疗超过 每年有25，000名退伍军人，使其成为VA住院的第二大最常见原因。而 大多数退伍军人在急性发作中幸存下来，许多人遭受不良的长期结果。约1/3 幸存者在败血症后的一年内死亡，五分之一的人有可能再次住院治疗，一名 6人经历严重的持续性身体或认知障碍。败血症的急剧增加 2019冠状病毒病给优化脓毒症生存带来了新的紧迫性，但也带来了新的学习机会 从医院实施以恢复为重点的做法，以解决退伍军人生存的需要， SARS冠状病毒二型引起的病毒性败血症 意义尽管脓毒症后的长期发病率很高， 指南着重于促进脓毒症的康复。OVeR-Sepsis将满足紧急临床需求 在弗吉尼亚州，促进每年数千名败血症幸存的退伍军人的康复（包括 病毒性败血症）。OVeR-Sepsis将验证促进脓毒症恢复的最佳实践 对退伍军人和护理人员的观点作出反应，并确定可行的战略， 实施.我们将使这些工具免费提供，易于使用，并在全国范围内推广， 鼓励他们使用。 创新与影响。OVeR-Sepsis通过系统地研究脓毒症存活率而创新， 大致上我们将研究COVID和非COVID败血症的生存率，并考虑如何 COVID脓毒症生存实践的创新可以为非COVID脓毒症幸存者的实践提供信息。 我们的顺序解释混合方法的方法，与视频网站访问4-6顶部和4-6底部- 执行网站败血症生存，将使我们能够研究的临床实践和实施 这些策略使表现最好的网站脱颖而出。然后，我们将纳入我们的定性调查结果 对证据综合的现场访问，通知修改后的德尔菲小组评估以下方面的最佳做法： 脓毒症康复 具体目标。(A1)确定表现最好和最差的VA医院，以获得90天生存率和 脓毒症后的生活(A2)定义通过电子技术区分高绩效医院的实践 健康记录分析、调查和视频网站访问。(A3)优先考虑脓毒症康复的最佳实践 基于有效性、改进机会和可行性。 方法论我们将测量VA医院中脓毒症的风险标准化90天生存率 使用分层回归模型和2017-2020年CDW数据。然后我们将挑选一批 N=600名退伍军人（每家医院25名退伍军人，来自12家生存率较高和12家生存率较低的医院）至 使用电话调查工具和代理受访者选项来衡量生活质量和残疾状况。 从中，我们将选择4-6个表现最好的（生存率高，生活质量高）和4-6个表现最差的， 对医院进行360度视频访问。通过对某些做法的定量分析， 对现行做法的调查，以及对12-15名不同的被调查者进行的半结构化访谈 （临床医生，管理人员，退伍军人，护理人员），我们将确定脓毒症康复的“最佳实践” 和相关的实施战略。使用修改后的德尔菲专家小组，我们将评估 这些最佳实践的有效性、改进机会和可行性。 后续步骤/实施。在成功完成这项研究后，我们将与我们的 业务合作伙伴-我们甚至在这个IIR的设计阶段就包括在内-以实现这些目标 最佳实践

Background. Sepsis—life-threatening organ dysfunction triggered by infection—hospitalizes more than 25,000 Veterans each year, making it the 2nd most common reason for hospitalization in the VA. While most Veterans survive the acute episode, many suffer poor longer term outcomes. Approximately 1 in 3 survivors die in the year following sepsis, 1 in 5 have a potentially preventable rehospitalization, and 1 in 6 experience severe persistent physical or cognitive impairments. The dramatic increase in sepsis from COVID-19 brings new urgency to optimizing sepsis survivorship, but also new opportunity to learn from hospitals implementing recovery-focused practices to address the needs of Veterans surviving viral sepsis from SARS-CoV-2. Significance. Despite the prevalence of long-term morbidity after sepsis, there are no treatment guidelines focused on enhancing recovery from sepsis. OVeR-Sepsis will meet an urgent clinical need in VA, enhancing the recovery of the thousands of Veterans who survive sepsis each year (including viral sepsis from COVID). OVeR-Sepsis will validate best practices for enhancing recovery from sepsis that are responsive to Veteran and caregiver perspectives and identify feasible strategies for implementation. We will make these tools freely available, easy to use, and promote them nationally to encourage their use. Innovation and Impact. OVeR-Sepsis is innovative by studying sepsis survivorship systematically and broadly. We will study survivorship from both COVID and non-COVID sepsis, and consider how innovation in COVID sepsis survivorship practices can inform practice for non-COVID sepsis survivors. Our sequential explanatory mixed methods approach, with video site visits for 4-6 top- and 4-6 bottom- performing sites for sepsis survivorship, will allow us to study of clinical practices and implementation strategies that differentiate top-performing sites. We will then incorporate qualitative findings from our site visits into the evidence synthesis informing a modified Delphi panel to assess best practices for sepsis recovery. Specific Aims. (A1) Identify top- and bottom-performing VA hospitals for 90-day survival and quality of life after sepsis. (A2) Define practices that differentiate top-performing hospitals through electronic health record analysis, surveys, and video site visits. (A3) Prioritize best practices for sepsis recovery based on validity, improvement opportunity, and feasibility. Methodology. We will measure risk-standardized 90-day survival from sepsis across VA hospitals using hierarchical regression models and 2017-2020 CDW data. We will then empanel a cohort of N=600 Veterans from (25 Veterans per hospital, from 12 higher- and 12-lower survival hospitals) to measure quality of life and disability using telephone survey instruments with proxy respondent options. From those, we will select 4-6 top-performing (higher survival, high quality of life) and 4-6 bottom- performing hospitals for 360-degree video site visits. Through quantitative analyses of select practices, survey of current practices, and semi-structured interviews with a diverse set of 12-15 informants (clinicians, administrators, Veterans, caregivers), we will identify “best practices” for sepsis recovery and associated implementation strategies. Using a modified Delphi panel of experts, we will assess the validity, improvement opportunity, and feasibility of these best practices. Next Steps/Implementation. Upon successful completion of this research, we will work with our operational partners—who we have included even in the design stage of this IIR—to implement these best practices.