Providence Swedish, Seattle, WA; University of Washington, Seattle, WA.
Providence Center for Cardiovascular Analytics, Research and Data Science, Portland, OR.
Chest. 2024 Nov;166(5):1046-1055. doi: 10.1016/j.chest.2024.05.032. Epub 2024 Jun 19.
Sepsis is common and expensive, and evidence suggests that sepsis order sets may help to improve care. Very incomplete evidence exists regarding the effects of sepsis order sets on the value of care produced by hospitals or the societal costs of sepsis care.
In patients hospitalized for sepsis, is the receipt a of a sepsis order set vs no order set associated with improved value of care, defined as decreased hospital mortality, decreased hospital direct variable costs, and decreased societal spending on hospitalizations?
This retrospective cohort study included patients discharged with sepsis International Classification of Diseases, Tenth Revision, codes over 2 years from a large integrated delivery system. Using a propensity score, sepsis order set users were matched to nonusers to study the association between sepsis order set use and the value of care from the hospital and societal perspective. The association between order set receipt and hospital mortality, direct variable cost, and hospital revenue also were examined in a priori defined subgroups of sepsis severity and hospital mortality.
The study included 97,249 patients, with 52,793 patients (54%) receiving the sepsis order set. The propensity score match analysis included 55,542 patients, with 27,771 patients in each group. Recipients of the sepsis order set showed a 3.3% lower hospital mortality rate and a $1,487 lower median direct variable total cost (P < .01 for both). Median payer-neutral reimbursement (ie, PNR), a proxy for hospital revenue and thus societal costs, was $465 lower for sepsis order set users (P < .01). Receipt of the sepsis order set was associated with a $1,022 increase in contribution margin, the difference between direct variable costs and PNR per patient.
Receipt of the sepsis order set was associated with improved value of care, from both a hospital and societal perspective.
脓毒症很常见且费用高昂，有证据表明脓毒症医嘱集可能有助于改善治疗。关于脓毒症医嘱集对医院提供的护理价值或脓毒症护理的社会成本的影响，仅有非常不完整的证据。
在因脓毒症住院的患者中，与未使用医嘱集相比，使用脓毒症医嘱集是否与改善护理价值相关，护理价值的定义为降低医院死亡率、降低医院直接变动成本和降低社会住院支出？
本回顾性队列研究纳入了来自大型综合医疗系统的 2 年期间出院诊断为脓毒症的患者（国际疾病分类第 10 版）。使用倾向评分，将脓毒症医嘱集使用者与非使用者进行匹配，以研究从医院和社会角度来看，使用脓毒症医嘱集与护理价值之间的关联。还在脓毒症严重程度和医院死亡率的预先定义亚组中，检验了医嘱集使用与医院死亡率、直接变动成本和医院收入之间的关联。
该研究纳入了 97249 例患者，其中 52793 例（54%）患者接受了脓毒症医嘱集。倾向评分匹配分析共纳入 55542 例患者，每组 27771 例。脓毒症医嘱集使用者的医院死亡率降低了 3.3%，中位直接变动总成本降低了 1487 美元（均 P <.01）。脓毒症医嘱集使用者的中位支付方中立补偿（即 PNR）较低，为 465 美元（P <.01），PNR 是医院收入的替代指标，也是社会成本的替代指标。脓毒症医嘱集使用者的边际贡献增加了 1022 美元，即每位患者的直接变动成本与 PNR 之间的差异。
从医院和社会角度来看，使用脓毒症医嘱集与改善护理价值相关。
