Effect of a Multicomponent Sepsis Transition and Recovery Program on Mortality and Readmissions After Sepsis : The Improving Morbidity During Post-Acute Care Transitions for Sepsis Randomized Clinical Trial
Copyright © 2021 by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. All Rights Reserved..
OBJECTIVES: To evaluate whether a nurse navigator-led, multicomponent Sepsis Transition And Recovery program improves 30-day mortality and readmission outcomes after sepsis hospitalization.
DESIG: n: Multisite pragmatic randomized clinical trial.
SETTING: Three hospitals in North Carolina from January 2019 to March 2020.
PATIENTS: Eligible patients hospitalized for suspected sepsis and deemed high-risk for mortality or readmission by validated internal risk models.
INTERVENTIONS: Patients were randomized to receive usual care alone (i.e., routine transition support, outpatient care; n = 342) or additional Sepsis Transition And Recovery support (n = 349). The 30-day intervention involved a multicomponent transition service led by a nurse navigator through telephone and electronic health record communication to facilitate best practice postsepsis care strategies during and after hospitalization including: postdischarge medication review, evaluation for new impairments or symptoms, monitoring comorbidities, and palliative care approach when appropriate. Clinical oversight was provided by a Hospital Medicine Transition Services team.
MEASUREMENTS AND MAIN RESULTS: The primary outcome was a composite of mortality or hospital readmission at 30 days. Logistic regression models were constructed to evaluate marginal and conditional odds ratios (adjusted for prognostic covariates: age, comorbidity, and organ dysfunction at enrollment). Among 691 randomized patients (mean age = 63.7 ± 15.1 yr; 52% female), a lower percentage of patients in the Sepsis Transition And Recovery group experienced the primary outcome compared with the usual care group (28.7% vs 33.3%; risk difference, 4.7%; odds ratio, 0.80; 95% CI, 0.58-1.11; adjusted odds ratio, 0.80; 95% CI, 0.64-0.98). There were 74 deaths (Sepsis Transition And Recovery: 33 [9.5%] vs usual care: 41 [12.0%]) and 155 rehospitalizations (Sepsis Transition And Recovery: 71 [20.3%] vs usual care: 84 [24.6%]).
CONCLUSIONS: In a multisite randomized clinical trial of patients hospitalized with sepsis, patients provided with a 30-day program using a nurse navigator to provide best practices for postsepsis care experienced a lower proportion of either mortality or rehospitalization within 30 days after discharge. Further research is needed to understand the contextual factors associated with successful implementation.
| Errataetall: |
CommentIn: Crit Care Med. 2022 Mar 1;50(3):525-527. - PMID 35191876 |
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| Medienart: |
E-Artikel |
| Erscheinungsjahr: |
2022 |
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| Erschienen: |
2022 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:50 |
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| Enthalten in: |
Critical care medicine - 50(2022), 3 vom: 01. März, Seite 469-479 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Taylor, Stephanie Parks [VerfasserIn] |
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| Links: |
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| Themen: |
Journal Article |
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| Anmerkungen: |
Date Completed 10.03.2022 Date Revised 28.07.2023 published: Print CommentIn: Crit Care Med. 2022 Mar 1;50(3):525-527. - PMID 35191876 Citation Status MEDLINE |
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| doi: |
10.1097/CCM.0000000000005300 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM330760920 |
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| 100 | 1 | |a Taylor, Stephanie Parks |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a Effect of a Multicomponent Sepsis Transition and Recovery Program on Mortality and Readmissions After Sepsis |b The Improving Morbidity During Post-Acute Care Transitions for Sepsis Randomized Clinical Trial |
| 264 | 1 | |c 2022 | |
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| 500 | |a Date Completed 10.03.2022 | ||
| 500 | |a Date Revised 28.07.2023 | ||
| 500 | |a published: Print | ||
| 500 | |a CommentIn: Crit Care Med. 2022 Mar 1;50(3):525-527. - PMID 35191876 | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a Copyright © 2021 by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. All Rights Reserved. | ||
| 520 | |a OBJECTIVES: To evaluate whether a nurse navigator-led, multicomponent Sepsis Transition And Recovery program improves 30-day mortality and readmission outcomes after sepsis hospitalization | ||
| 520 | |a DESIG: n: Multisite pragmatic randomized clinical trial | ||
| 520 | |a SETTING: Three hospitals in North Carolina from January 2019 to March 2020 | ||
| 520 | |a PATIENTS: Eligible patients hospitalized for suspected sepsis and deemed high-risk for mortality or readmission by validated internal risk models | ||
| 520 | |a INTERVENTIONS: Patients were randomized to receive usual care alone (i.e., routine transition support, outpatient care; n = 342) or additional Sepsis Transition And Recovery support (n = 349). The 30-day intervention involved a multicomponent transition service led by a nurse navigator through telephone and electronic health record communication to facilitate best practice postsepsis care strategies during and after hospitalization including: postdischarge medication review, evaluation for new impairments or symptoms, monitoring comorbidities, and palliative care approach when appropriate. Clinical oversight was provided by a Hospital Medicine Transition Services team | ||
| 520 | |a MEASUREMENTS AND MAIN RESULTS: The primary outcome was a composite of mortality or hospital readmission at 30 days. Logistic regression models were constructed to evaluate marginal and conditional odds ratios (adjusted for prognostic covariates: age, comorbidity, and organ dysfunction at enrollment). Among 691 randomized patients (mean age = 63.7 ± 15.1 yr; 52% female), a lower percentage of patients in the Sepsis Transition And Recovery group experienced the primary outcome compared with the usual care group (28.7% vs 33.3%; risk difference, 4.7%; odds ratio, 0.80; 95% CI, 0.58-1.11; adjusted odds ratio, 0.80; 95% CI, 0.64-0.98). There were 74 deaths (Sepsis Transition And Recovery: 33 [9.5%] vs usual care: 41 [12.0%]) and 155 rehospitalizations (Sepsis Transition And Recovery: 71 [20.3%] vs usual care: 84 [24.6%]) | ||
| 520 | |a CONCLUSIONS: In a multisite randomized clinical trial of patients hospitalized with sepsis, patients provided with a 30-day program using a nurse navigator to provide best practices for postsepsis care experienced a lower proportion of either mortality or rehospitalization within 30 days after discharge. Further research is needed to understand the contextual factors associated with successful implementation | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a Pragmatic Clinical Trial | |
| 650 | 4 | |a Randomized Controlled Trial | |
| 700 | 1 | |a Murphy, Stephanie |e verfasserin |4 aut | |
| 700 | 1 | |a Rios, Aleta |e verfasserin |4 aut | |
| 700 | 1 | |a McWilliams, Andrew |e verfasserin |4 aut | |
| 700 | 1 | |a McCurdy, Lewis |e verfasserin |4 aut | |
| 700 | 1 | |a Chou, Shih-Hsiung |e verfasserin |4 aut | |
| 700 | 1 | |a Hetherington, Timothy |e verfasserin |4 aut | |
| 700 | 1 | |a Rossman, Whitney |e verfasserin |4 aut | |
| 700 | 1 | |a Russo, Mark |e verfasserin |4 aut | |
| 700 | 1 | |a Gibbs, Michael |e verfasserin |4 aut | |
| 700 | 1 | |a Kowalkowski, Marc A |e verfasserin |4 aut | |
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