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. 2018 Dec 1;198(11):1406-1412.
doi: 10.1164/rccm.201712-2545OC.

Mortality Changes Associated with Mandated Public Reporting for Sepsis. The Results of the New York State Initiative

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Mortality Changes Associated with Mandated Public Reporting for Sepsis. The Results of the New York State Initiative

Mitchell M Levy et al. Am J Respir Crit Care Med. .

Abstract

Rationale: In 2013, the New York State Department of Health (NYSDOH) began a mandatory state-wide initiative to improve early recognition and treatment of severe sepsis and septic shock.

Objectives: This study examines protocol initiation, 3-hour and 6-hour sepsis bundle completion, and risk-adjusted hospital mortality among adult patients with severe sepsis and septic shock.

Methods: Cohort analysis included all patients from all 185 hospitals in New York State reported to the NYSDOH from April 1, 2014, to June 30, 2016. A total of 113,380 cases were submitted to NYSDOH, of which 91,357 hospitalizations from 183 hospitals met study inclusion criteria. NYSDOH required all hospitals to submit and follow evidence-informed protocols (including elements of 3-h and 6-h sepsis bundles: lactate measurement, early blood cultures and antibiotic administration, fluids, and vasopressors) for early identification and treatment of severe sepsis or septic shock.

Measurements and main results: Compliance with elements of the sepsis bundles and risk-adjusted mortality were studied. Of 91,357 patients, 74,293 (81.3%) had the sepsis protocol initiated. Among these individuals, 3-hour bundle compliance increased from 53.4% to 64.7% during the study period (P < 0.001), whereas among those eligible for the 6-hour bundle (n = 35,307) compliance increased from 23.9% to 30.8% (P < 0.001). Risk-adjusted mortality decreased from 28.8% to 24.4% (P < 0.001) in patients among whom a sepsis protocol was initiated. Greater hospital compliance with 3-hour and 6-hour bundles was associated with shorter length of stay and lower risk and reliability-adjusted mortality.

Conclusions: New York's statewide initiative increased compliance with sepsis-performance measures. Risk-adjusted sepsis mortality decreased during the initiative and was associated with increased hospital-level compliance.

Keywords: implementation science; performance improvement; quality; sepsis.

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Figures

Figure 1.
Figure 1.
Compliance with the 3-hour bundle and the 6-hour bundle over time. The regression lines for bundle compliance are based on individual unadjusted logistic regression models with time entered as a square root expression (3-h model) and a quadratic expression (6-h model). Using the 27 monthly observations, 3-hour bundle compliance and 6-hour bundle compliance increase 0.43% per month (95% confidence interval, 0.37–0.49%; P < 0.001) and 0.54% per month (95% confidence interval, 0.49–0.58%; P < 0.001), respectively.
Figure 2.
Figure 2.
Change in risk-adjusted mortality over time. Time is entered into the risk-adjusted hospital mortality model as a linear expression. Using the 27 monthly observations, risk-adjusted mortality decreases 0.17% per month (95% confidence interval, 0.167–0.169; P < 0.001).
Figure 3.
Figure 3.
Risk-adjusted hospital mortality over time by protocol initiation status. Risk-adjusted mortality improved in patients with a sepsis protocol initiated throughout the study period, but it was stable for patients without a protocol initiated. The difference in mortality between patients treated with and without a sepsis protocol first became significant (P = 0.019) during the third month of the study.

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References

    1. Angus DC, Linde-Zwirble WT, Lidicker J, Clermont G, Carcillo J, Pinsky MR. Epidemiology of severe sepsis in the United States: analysis of incidence, outcome, and associated costs of care. Crit Care Med. 2001;29:1303–1310. - PubMed
    1. Martin GS, Mannino DM, Eaton S, Moss M. The epidemiology of sepsis in the United States from 1979 through 2000. N Engl J Med. 2003;348:1546–1554. - PubMed
    1. Elixhauser A, Friedman B, Stranges E. Septicemia in US Hospitals, HCUP Statistical Brief #122. Rockville, MD; 2011 [accessed 2011 Nov 18]. Available from: http://www.hcup-us.ahrq.gov/reports/statbriefs/sb122.pdf.
    1. Liu V, Escobar GJ, Greene JD, Soule J, Whippy A, Angus DC, et al. Hospital deaths in patients with sepsis from 2 independent cohorts. JAMA. 2014;312:90–92. - PubMed
    1. 10 CRR-NY 405.4. Westlaw. Thomson Reuters [accessed 2017 Feb 11]. Available from: https://govt.westlaw.com/nycrr/Document/I4fe39657cd1711dda432a117e6e0f34....

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