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Association between Adherence to Recommended Care and Outcomes for Adult Survivors of Sepsis.
Ann Am Thorac Soc. 2019 Oct 23;:
Authors: Taylor SP, Chou SH, Figueroa Sierra M, Shuman TP, McWilliams AD, Taylor BT, Russo M, Evans SL, Rossman W, Murphy S, Cunningham K, Kowalkowski MA
Abstract
RATIONALE: Post-sepsis care recommendations target specific deficits experienced by sepsis survivors, including optimizing medications, screening for functional impairments, monitoring for common and preventable causes for health deterioration, and consideration of palliative care. However, there are few data describing application of these elements in clinical practice.
OBJECTIVE: To quantify the delivery of post-sepsis care for patients discharged following hospital admission for sepsis and evaluate the association between receipt of post-sepsis care elements and reduced mortality and hospital readmission within 90 days.
METHODS: We conducted a retrospective chart review of a random sample of patients discharged alive following an admission for sepsis (identified from discharge ICD-10 codes) at ten hospitals during 2017. We used a structured chart abstraction to determine whether four elements of post-sepsis care were provided within 90 days of hospital discharge, per expert recommendations. We used multivariable logistic regression to evaluate the association between receipt of care elements and 90-day hospital readmission and mortality, adjusted for age, comorbidity, length of stay, and discharge disposition.
RESULTS: Among 189 sepsis survivors, 117 (62%) had medications optimized, 123 (65%) had screening for functional or mental health impairments, 86 (46%) were monitored for common and preventable causes for health deterioration, and 110 (58%) had care alignment processes documented (i.e., assessed for palliative care or goals of care). Only 20 (11%) received all four care elements within 90 days. Within 90 days of discharge, 66 (35%) patients were readmitted and 33 (17%) died (total patients readmitted or died, n=82). Receipt of two (odds ratio [OR]=0.26, 0.10-0.69) or more (three OR=0.28, 0.11-0.72; four OR=0.12, 0.03-0.50) care elements was associated with lower odds of 90-day readmission or 90-day mortality, compared to none or one element documented. Optimization of medications (no medication errors versus ≥1 error; OR=0.44, 0.21-0.92), documented functional or mental health assessments (physical function plus swallowing/mental health assessments versus no assessments; OR=0.14, 0.05-0.40), and documented goals of care or palliative care screening (OR=0.52, 0.25-1.05; not statistically significant) were associated with lower odds of 90-day readmission or 90-day mortality.
CONCLUSIONS: In this retrospective cohort study from a single health system we found variable delivery of recommended post-sepsis care elements that were associated with reduced morbidity and mortality following sepsis hospitalization. Implementation strategies to efficiently overcome barriers to adoption of recommended post-sepsis care may help improve sepsis survivor outcomes.
PMID: 31644304 [PubMed - as supplied by publisher]