Colucciello Nicholas A, Kowalkowski Marc A, Kooken Maria, Wardi Gabriel, Taylor Stephanie P
Department of Internal Medicine, Atrium Health, Charlotte, NC, USA.
Center for Outcomes Research and Evaluation, Atrium Health, Charlotte, NC, USA.
J Am Med Dir Assoc. 2023 May;24(5):742-746.e1. doi: 10.1016/j.jamda.2023.02.009. Epub 2023 Mar 11.
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.
Secondary analysis of a multisite pragmatic randomized clinical trial.
Sepsis survivors discharged to post-acute care.
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.
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)].
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.
出院后进入急性后护理机构的脓毒症幸存者死亡率和再入院率较高。本研究比较了脓毒症过渡与康复（STAR）计划与常规护理（UC）对出院后进入急性后护理机构的脓毒症幸存者30天死亡率和再入院率的影响。
对一项多中心实用随机临床试验进行二次分析。
出院后进入急性后护理机构的脓毒症幸存者。
我们对IMPACTS（改善脓毒症急性后护理过渡期间的发病率）随机临床试验中出院后进入急性后护理机构的患者进行了二次分析。IMPACTS评估了STAR的有效性，这是一个由护士导航员主导的计划，旨在提供脓毒症最佳实践护理。受试者被随机分配接受STAR或UC。主要结局是30天再入院率和死亡率。我们还将无住院天数作为次要结局进行了评估。
在IMPACTS纳入的691例患者中，175例（25%）出院后进入急性后护理机构[143例（82%）进入熟练护理机构，12例（7%）进入长期急性护理医院，20例（11%）进入住院康复机构]。其中，87例接受UC，88例接受STAR干预。UC组26例（29.9%）患者出现30天全因死亡率和再入院复合终点，而STAR组为18例（20.5%）[风险差异-9.4%（95%CI-22.2至3.4）；调整后的优势比为0.58（95%CI0.28至1.17）]。单独来看，UC组30天全因死亡率为8.1%，而STAR组为5.7%[风险差异-2.4%（95%CI-9.9至5.1）]，UC组30天全因再入院率为26.4%，而STAR计划组为17.1%[风险差异-9.4%（95%CI-21.5至2.8）]。
几乎没有经过验证的干预措施可降低出院后进入急性后护理机构患者的再入院率。这些结果表明，STAR计划可能会降低出院后进入急性后护理机构的脓毒症幸存者的30天死亡率和再入院率。
