Characterizing Program Delivery for an Effective Multicomponent Sepsis Recovery Intervention

Abstract

Rationale: A recent randomized controlled trial revealed that a multicomponent sepsis transition and recovery (STAR) program delivered through specialized nurse navigators was effective in reducing a composite of 30-day readmission and mortality. Better understanding of patterns of care provided by the STAR program is needed to promote implementation and dissemination of this effective program.Objectives: This study characterizes individual care activities and distinct "packages" of care delivered by the STAR program.Methods: We performed a secondary analysis of data from the intervention arm of the IMPACTS (Improving Morbidity during Post-Acute Care Transitions for Sepsis) randomized controlled trial, conducted at three urban hospitals in the southeastern United States from January 2019 to March 2020. We used a structured data collection process to identify STAR nurse navigator care activities from electronic health record documentation. We then used latent class analysis to identify groups of patients receiving distinct combinations of intervention components. We evaluated differences in patient characteristics and outcomes between groups receiving distinct intervention packages.Results: The 317 sepsis survivors enrolled into the intervention arm of the IMPACTS trial received one or more of nine unique care activities delivered by STAR nurse navigators (care coordination, health promotion counseling, emotional listening, symptom management, medication management, chronic disease management, addressing social determinants of health, care setting advice and guidance, and primary palliative care). Patients received a median of three individual care activities (interquartile range, 2-5). Latent class analysis revealed four distinct packages of care activities delivered to patients with different observable characteristics and different frequency of 30-day readmission and mortality.Conclusions: We identified nine care activities delivered by an effective STAR program and four distinct latent classes or packages of intervention delivery. These results can be leveraged to increase widespread implementation and provide targets to augment future program delivery.

Keywords: mortality; readmission; recovery; sepsis; septic shock.

Figure 1.

Heatmap displaying the standardized mean values for receipt of each intervention component indicator across four classes, with description of total program engagement. The heatmap is shaded according to the proportion of each indicator in the four latent classes. Values represent a relative increase (red) or decrease (blue) from the mean of the proportion in the overall cohort, with darker gradients depicting larger relative differences (i.e., up to ±1 standard deviation from the mean). SE = standard error.

Figure 2.

(A and B) Distribution (A) and pairwise comparisons (B) of composite 30-day hospital readmission and mortality outcomes for four-class model of sepsis transition and recovery program receipt. The primary outcome is a composite of 30-day hospital readmission and mortality. The model is adjusted for age, comorbidity score, and number of failed organs. CI = confidence interval; OR = odds ratio.