Department of Health Policy and Management, Yale School of Public Health, New Haven, USA.
Yale Global Health Leadership Initiative, Yale School of Public Health, New Haven, USA.
BMC Health Serv Res. 2022 Jul 30;22(1):975. doi: 10.1186/s12913-022-08331-5.
Sepsis affects 1.7 million patients in the US annually, is one of the leading causes of mortality, and is a major driver of US healthcare costs. African American/Black and LatinX populations experience higher rates of sepsis complications, deviations from standard care, and readmissions compared with Non-Hispanic White populations. Despite clear evidence of structural racism in sepsis care and outcomes, there are no prospective interventions to mitigate structural racism in sepsis care, nor are we aware of studies that report reductions in racial inequities in sepsis care as an outcome. Therefore, we will deliver and evaluate a coalition-based intervention to equip health systems and their surrounding communities to mitigate structural racism, driving measurable reductions in inequities in sepsis outcomes. This paper presents the theoretical foundation for the study, summarizes key elements of the intervention, and describes the methodology to evaluate the intervention.
Our aims are to: (1) deliver a coalition-based leadership intervention in eight U.S. health systems and their surrounding communities; (2) evaluate the impact of the intervention on organizational culture using a longitudinal, convergent mixed methods approach, and (3) evaluate the impact of the intervention on reduction of racial inequities in three clinical outcomes: a) early identification (time to antibiotic), b) clinical management (in-hospital sepsis mortality) and c) standards-based follow up (same-hospital, all-cause sepsis readmissions) using interrupted time series analysis.
This study is aligned with calls to action by the NIH and the Sepsis Alliance to address inequities in sepsis care and outcomes. It is the first to intervene to mitigate effects of structural racism by developing the domains of organizational culture that are required for anti-racist action, with implications for inequities in complex health outcomes beyond sepsis.
每年有 170 万美国患者受到脓毒症的影响，它是导致死亡的主要原因之一，也是美国医疗保健成本的主要驱动因素。与非西班牙裔白人相比，非裔/黑人和拉丁裔人群的脓毒症并发症、偏离标准护理和再入院率更高。尽管脓毒症护理和结果中存在明显的结构性种族主义证据，但目前没有针对脓毒症护理中结构性种族主义的前瞻性干预措施，我们也不知道有研究报告将脓毒症护理中的种族不平等减少作为结果。因此，我们将提供并评估一个基于联盟的干预措施，以使卫生系统及其周围社区能够减轻结构性种族主义，从而在脓毒症结果方面实现可衡量的减少不平等。本文介绍了该研究的理论基础，总结了干预措施的关键要素，并描述了评估干预措施的方法。
我们的目标是：(1) 在八个美国卫生系统及其周围社区开展基于联盟的领导力干预；(2) 使用纵向、收敛混合方法评估干预对组织文化的影响，以及 (3) 使用中断时间序列分析评估干预对减少三种临床结果中的种族不平等的影响：a) 早期识别（抗生素使用时间）、b) 临床管理（院内脓毒症死亡率）和 c) 基于标准的后续治疗（同一医院，所有原因的脓毒症再入院率）。
这项研究符合 NIH 和脓毒症联盟提出的行动呼吁，旨在解决脓毒症护理和结果中的不平等问题。这是第一个通过开发组织文化的领域来干预减轻结构性种族主义影响的研究，这些领域是反种族主义行动所必需的，对脓毒症以外的复杂健康结果中的不平等具有重要意义。
