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The regulation of sepsis care in New York State may have had a deeper than expected impact on hospital mortality.
A recent study found that the implementation of state-mandated sepsis care resulted in a reduction in hospital mortality almost twice that of states that had not undergone a similar change in mortality. regulation.
"In the United States, we rarely require hospitals to implement specific clinical protocols. Typically, quality improvement is achieved through financial incentives and public reporting, "said lead researcher Jeremy Kahn, MD, MS, a professor at the University of Pittsburgh's School of Medicine. "For the first time, state authorities have included in the regulations that hospitals must follow certain protocols based on evidence of sepsis. And our study shows that, at least in New York, it seemed to work. "
After the adoption of Rory's By-Laws in 2013, physicians across the country began to pay more and more attention to the effects of these mandatory protocols on hospital-grade mortality in sepsis patients. To evaluate the impact, the investigators compared data on adult hospitalized patients for sepsis between New York and 4 control states, using hospital discharge data from all sources of responsibility. . The states of control were Florida, Maryland, Mbadachusetts and New Jersey.
The main endpoint of the study was mortality at the hospital within 30 days. Secondary outcomes were ICU admission rates, central venous catheter use, Clostridium difficile infection rates, and length of stay in hospital.
The period from January 1, 2011 to March 31, 2013 was designated as the period before and after the definition between April 1, 2013 and September 30, 2015. The final badysis covered a total of 1,012,410 admissions for sepsis from 509 hospitals.
The average age of the study population was 69.5 years and 47.9% were women. Investigators identified 139,019 pre-regulatory patients in New York State and 289,225 patients from 4 control states during the same period. Investigators identified 186,767 patients in New York after the initiation of the protocols. A group of 397,999 patients from control states were admitted during this period.
Unadjusted mortality at the hospital within 30 days at the hospital was 26.3% in New York and 22% in control states before the regulation came into effect. After adjusting for patient and hospital characteristics, mortality after regulatory implementation decreased significantly in New York compared with control states.
Investigators noted that in the 10th quarter following implementation, the adjusted mortality rate was 3.2% lower than forecast in New York compared to the control states. In addition, the regulations were not badociated with any significant difference between admission rates in intensive care units, a significant relative decrease in length of stay in hospital, and a significant relative increase in utilization. central venous catheter and a significant relative decrease in the rate of C difficile infection.
In a note from the attached publisher, Demetrios Kyriacou, MD, Ph.D., a professor at the Feinberg School of Medicine at Northwestern University, says the findings suggesting a larger than expected reduction are important to demonstrate the # 39 effectiveness of public health interventions, but aware of the negative consequences of mandatory directives.
"Regulation of prescribed care generally requires increased administrative and clinical resources," wrote Kyriacou. "Unless additional resources are specifically dedicated to compliance with new regulations, resources could be diverted away from other critical care interventions. The New York State government's approach to improving general care and outcomes in sepsis is an experiment. "
This study, "Association Between Treatment of Prescribed State-Prescribed Sepsis and In-Hospital Mortality in Adults with Sepsis" is published in JAMA.
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