J Am Med Dir Assoc. 2023 Mar 11:S1525-8610(23)00128-7. doi: 10.1016/j.jamda.2023.02.009. Online ahead of print.
OBJECTIVES: Sepsis survivors discharged to post-acute care facilities experience high rates of mortality and hospital readmission. This study compared the effects of a Sepsis Transition and Recovery (STAR) program vs usual care (UC) on 30-day mortality and hospital readmission among sepsis survivors discharged to post-acute care.
DESIGN: Secondary analysis of a multisite pragmatic randomized clinical trial.
SETTING AND PARTICIPANTS: Sepsis survivors discharged to post-acute care.
METHODS: We conducted a secondary analysis of patients from the IMPACTS (Improving Morbidity During Post-Acute Care Transitions for Sepsis) randomized clinical trial who were discharged to post-acute care. IMPACTS evaluated the effectiveness of STAR, a nurse-navigator-led program to deliver best practice post-sepsis care. Subjects were randomized to receive either STAR or UC. The primary outcome was 30-day readmission and mortality. We also evaluated hospital-free days alive as a secondary outcome.
RESULTS: Of 691 patients enrolled in IMPACTS, 175 (25%) were discharged to post-acute care (143 [82%] to skilled nursing facilities, 12 [7%] to long-term acute care hospitals, and 20 [11%] to inpatient rehabilitation). Of these, 87 received UC and 88 received the STAR intervention. The composite 30-day all-cause mortality and readmission endpoint occurred in 26 (29.9%) patients in the UC group vs 18 (20.5%) in the STAR group (risk difference -9.4% [95% CI -22.2 to 3.4]; adjusted odds ratio 0.58 [95% CI 0.28 to 1.17]). Separately, 30-day all-cause mortality was 8.1% in the UC group compared with 5.7% in the STAR group (risk difference -2.4% [95% CI -9.9 to 5.1]) and 30-day all-cause readmission was 26.4% in the UC group compared with 17.1% in the STAR program (risk difference -9.4% [95% CI -21.5 to 2.8]).
CONCLUSIONS AND IMPLICATIONS: There are few proven interventions to reduce readmission among patients discharged to post-acute care facilities. These results suggest the STAR program may reduce 30-day mortality and readmission rates among sepsis survivors discharged to post-acute care facilities.
PMID:36918147 | DOI:10.1016/j.jamda.2023.02.009