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Does Early Follow-Up Improve the Outcomes of Sepsis Survivors Discharged to Home Health Care?

Deb, Partha PhD*; Murtaugh, Christopher M. PhD; Bowles, Kathryn H. PhD, FAAN, FACMI†,‡; Mikkelsen, Mark E. MD, MSCE§; Khajavi, Hoda Nouri MS; Moore, Stanley BS; Barrón, Yolanda MS; Feldman, Penny H. PhD

doi: 10.1097/MLR.0000000000001152
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Background: There is little evidence to guide the care of over a million sepsis survivors following hospital discharge despite high rates of hospital readmission.

Objective: We examined whether early home health nursing (first visit within 2 days of hospital discharge and at least 1 additional visit in the first posthospital week) and early physician follow-up (an outpatient visit in the first posthospital week) reduce 30-day readmissions among Medicare sepsis survivors.

Design: A pragmatic, comparative effectiveness analysis of Medicare data from 2013 to 2014 using nonlinear instrumental variable analysis.

Subjects: Medicare beneficiaries in the 50 states and District of Columbia discharged alive after a sepsis hospitalization and received home health care.

Measures: The outcomes, protocol parameters, and control variables were from Medicare administrative and claim files and the home health Outcome and Assessment Information Set (OASIS). The primary outcome was 30-day all-cause hospital readmission.

Results: Our sample consisted of 170,571 mostly non-Hispanic white (82.3%), female (57.5%), older adults (mean age, 76 y) with severe sepsis (86.9%) and a multitude of comorbid conditions and functional limitations. Among them, 44.7% received only the nursing protocol, 11.0% only the medical doctor protocol, 28.1% both protocols, and 16.2% neither. Although neither protocol by itself had a statistically significant effect on readmission, both together reduced the probability of 30-day all-cause readmission by 7 percentage points (P=0.006; 95% confidence interval=2, 12).

Conclusions: Our findings suggest that, together, early postdischarge care by home health and medical providers can reduce hospital readmissions for sepsis survivors.

*Hunter College, City University of New York (CUNY) and National Bureau of Economic Research (NBER)

Center for Home Care Policy and Research, Visiting Nurse Service of New York, New York, NY

University of Pennsylvania School of Nursing

§Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA

Hunter College and the Graduate Center, City University of New York (CUNY), New York, NY

Independent Contractor, Bonny Doon, California

Supported by the National Institute of Nursing Research of the National Institutes of Health under Award Number R01NR016014.

The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

The authors declare no conflict of interest.

Reprints: Partha Deb, PhD, Economics Department, Hunter College, 695 Park Avenue, New York, NY 10065. E-mail: partha.deb@hunter.cuny.edu.

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