Optimizing Veteran Recovery from Sepsis (OVeR-Sepsis)

背景资料。脓毒症-感染引发的危及生命的器官功能障碍-住院的人数超过 每年有25,000名退伍军人，这使它成为退伍军人医院住院的第二大常见原因。而当 大多数退伍军人在急性发作中幸存下来，许多人遭受着糟糕的长期结果。约1/3 幸存者在脓毒症后的一年内死亡，五分之一的人有可能再次住院治疗，1人 有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 来自新冠肺炎给优化脓毒症生存带来新的迫切性，也带来了新的学习机会 来自医院实施以恢复为重点的做法，以满足幸存退伍军人的需求 SARS-CoV-2引起的病毒性败血症。 意义重大。尽管脓毒症后的长期发病率很高，但目前还没有治疗方法。 指南的重点是促进脓毒症的恢复。过度脓毒症将满足临床的迫切需求 在退伍军人管理局，加强每年在败血症中幸存下来的数千名退伍军人的康复(包括 来自COVID的病毒性败血症)。过度脓毒症将验证促进脓毒症恢复的最佳实践 响应退伍军人和护理者的观点，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 鼓励使用它们。 创新和影响力。通过系统地研究脓毒症的存活率和 大体上说。我们将研究COVID和非COVID败血症的存活率，并考虑如何 COVID败血症生存实践的创新可以为非COVID败血症幸存者的实践提供信息。 我们的顺序说明性混合方法方法，视频网站访问4-6顶部-和4-6底部- 脓毒症生存的现场表演，将使我们能够研究临床实践和实施 区分表现最好的网站的策略。然后，我们将结合我们的定性结果 对证据合成的现场访问，为修改后的德尔福小组提供信息，以评估 脓毒症痊愈。 明确的目标。(A1)确定表现最好和最差的退伍军人医院，以实现90天的生存和质量 败血症后的生活。(A2)定义通过电子设备区分一流医院的做法 健康记录分析、调查和视频网站访问。(A3)确定脓毒症恢复最佳做法的优先顺序 基于有效性、改进机会和可行性。 方法论。我们将测量退伍军人医院内脓毒症的风险标准化90天存活率。 使用分层回归模型和2017-2020年CDW数据。然后我们将派一队 N=600名退伍军人(每家医院25名退伍军人，从12家高生存医院和12家低生存医院)到 使用带有代理受访者选项的电话调查工具来衡量生活质量和残疾。 从这些中，我们将选出4-6个表现最好的(更高的存活率，更高的生活质量)和4-6个垫底的- 表演医院360度视频现场参观。通过对选定实践的量化分析， 对当前做法的调查，并与12-15名不同的线人进行半结构化访谈 (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 以及相关的实施战略。使用修改后的德尔福专家小组，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IIR的设计阶段就包括了他们-来实施这些 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.