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Patient Outcomes and Cost-Effectiveness of a Sepsis Care Quality Improvement Program in a Health System

Afshar, Majid MD, MSCR1,2,3; Arain, Erum MD1; Ye, Chen MD1; Gilbert, Emily MD1; Xie, Meng BS4; Lee, Josh MD1; Churpek, Matthew M. MD, MPH, PhD5; Durazo-Arvizu, Ramon PhD2,3; Markossian, Talar PhD2,3; Joyce, Cara PhD2,3

doi: 10.1097/CCM.0000000000003919
Clinical Investigation: PDF Only
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Objectives: Assess patient outcomes in patients with suspected infection and the cost-effectiveness of implementing a quality improvement program.

Design, Setting, and Participants: We conducted an observational single-center study of 13,877 adults with suspected infection between March 1, 2014, and July 31, 2017. The 18-month period before and after the effective date for mandated reporting of the sepsis bundle was examined. The Sequential Organ Failure Assessment score and culture and antibiotic orders were used to identify patients meeting Sepsis-3 criteria from the electronic health record.

Interventions: The following interventions were performed as follows: 1) multidisciplinary sepsis committee with sepsis coordinator and data abstractor; 2) education campaign; 3) electronic health record tools; and 4) a Modified Early Warning System.

Main Outcomes and Measures: Primary health outcomes were in-hospital death and length of stay. The incremental cost-effectiveness ratio was calculated and the empirical 95% CI for the incremental cost-effectiveness ratio was estimated from 5,000 bootstrap samples.

Results: In multivariable analysis, the odds ratio for in-hospital death in the post- versus pre-implementation periods was 0.70 (95% CI, 0.57–0.86) in those with suspected infection, and the hazard ratio for time to discharge was 1.25 (95% CI, 1.20–1.29). Similarly, a decrease in the odds for in-hospital death and an increase in the speed to discharge was observed for the subset that met Sepsis-3 criteria. The program was cost saving in patients with suspected infection (–$272,645.7; 95% CI, –$757,970.3 to –$79,667.7). Cost savings were also observed in the Sepsis-3 group.

Conclusions and Relevance: Our health system’s program designed to adhere to the sepsis bundle metrics led to decreased mortality and length of stay in a cost-effective manner in a much larger catchment than just the cohort meeting the Centers for Medicare and Medicaid Services measures. Our single-center model of interventions may serve as a practice-based benchmark for hospitalized patients with suspected infection.

1Department of Medicine, Loyola University Medical Center, Maywood, IL.

2Department of Public Health Sciences, Loyola University, Maywood, IL.

3Center for Health Outcomes and Informatics Research, Heath Sciences Research Campus, Loyola University, Maywood, IL.

4Department of Applied Statistics, Loyola University, Chicago, IL.

5Department of Medicine, The University of Chicago, Chicago, IL.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s website (http://journals.lww.com/ccmjournal).

Dr. Afshar received funding from the National Institute of Health (NIH)/National Institute of Alcoholism and Alcohol Abuse (K23 AA024503). Dr. Churpek received funding from the NIH/National Institute of General Medical Sciences (R01 GM 123193), NIH/National Heart, Lung, and Blood Institute (K08 HL121080), American Thoracic Society Foundation: Recognition Award for Early Career Investigators, and from a patent pending (ARCD. P0535US.P2). He received support for article research from the NIH. The remaining authors have disclosed that they do not have any potential conflicts of interest.

For information regarding this article, E-mail: Majid.afshar@lumc.edu

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