Patient safety and outcomes in sepsis

描述(由申请人提供)：败血症是美国第10大主要死亡原因，占住院人数的1/50以上。脓毒症的发病率和严重程度都在增加，还与极高的住院死亡率、幸存者死亡风险的增加以及卫生保健资源的大量使用有关。目前的指南侧重于通过旨在提高死亡率、降低并发症发生率、降低医疗保健利用率和成本的基于礼仪的干预措施，改善脓毒症护理的交付和质量。虽然初步研究表明危重患者容易受到医源性不良事件的影响，但在全国范围内还没有研究确定患者安全性与败血症患者预后之间的关系。通过利用医疗成本和利用项目全国住院患者样本中提供的数据，并评估医疗研究和质量机构的患者安全指标(PSI)，拟议的研究将提供新的见解，在国家层面上患者安全和脓毒症结果之间的联系。首先，这项研究将通过评估PSI事件的发生率来确定脓毒症患者的并发症发生率，并确定与普通医院人群相比，脓毒症患者是否面临更高的风险。其次，它将通过多变量病例匹配技术描述与PSI事件相关的超额死亡率、住院时间和住院费用。最后，它将通过使用分层统计模型来评估医院水平的患者安全措施是否与脓毒症结局相关。 公共卫生相关性：脓毒症是美国第十大死亡原因，与极高的住院死亡率、幸存者死亡风险增加以及医疗资源的大量使用有关。评估脓毒症患者的患者安全措施可以突出当前护理中潜在的不足之处。此外，它们还可用于提高脓毒症护理的质量和提供服务。

DESCRIPTION (provided by applicant): Sepsis is the 10th leading cause of death in the United States and accounts for more than 1 in 50 hospitalizations. Increasing in both incidence and severity, sepsis is also associated with extremely high in-hospital mortality rates, increased risks of death among survivors, and considerable use of healthcare resources. Current guidelines focus on improving the delivery and quality of sepsis care through protocol-based interventions aimed at improving mortality, decreasing complication rates, and reducing healthcare utilization and cost. While preliminary studies suggest that critically ill patients are vulnerable to iatrogenic adverse events, no studies have defined the association of patient safety and outcomes in sepsis patients nationally. By utilizing data available in the Healthcare Cost and Utilization Project National Inpatient Sample and evaluating the Agency for Healthcare Research and Quality's Patient Safety Indicators (PSI), the proposed study will provide novel insight into the association between patient safety and sepsis outcomes on a national level. First, the study will define the incidence of complications among patients with sepsis by evaluating the rate of PSI events and determine whether sepsis patients are at increased risk compared with the general hospital population. Second, it will describe the excess mortality, length of stay, and hospital cost associated with PSI events by multivariable case matching techniques. Finally, it will evaluate whether hospital-level measures of patient safety are associated with sepsis outcomes by using hierarchical statistical models. PUBLIC HEALTH RELEVANCE: Sepsis is the 10th leading cause of death in the United States and is associated with extremely high in-hospital mortality, increased risks of death among survivors, and considerable use of healthcare resources. Evaluating measures of patient safety in patients with sepsis can highlight potential areas of deficiency in current care. Moreover, they can be used to enhance the quality and delivery of sepsis care.