The effects of state sepsis mandates on hospital mortality, health care utilization, and costs

州脓毒症强制规定对医院死亡率、医疗保健利用率和成本的影响

• 批准号: 9980342
• 负责人: Jeremy M Kahn
• 金额: $ 38.04万
• 依托单位: UNIVERSITY OF PITTSBURGH AT PITTSBURGH
• 依托单位国家: 美国
• 财政年份: 2017
• 资助国家: 美国
• 起止时间: 2017-09-01 至 2022-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9980342
• 关键词: effects; state; sepsis; mandates; hospital

ABSTRACT Sepsis is a leading cause of morbidity and mortality in the United States, affecting over 750,000 Americans each year at an annual cost of over $20 billion. Several medical treatments are of proven effectiveness in this population, including timely administration of antibiotics and early resuscitation with intravenous fluids. However these treatments are inconsistently applied, creating an important quality gap. Protocols for early recognition and treatment can help close this gap and save lives in patients with sepsis, and in turn policy makers are increasingly using legal mechanisms to incentivize the use of sepsis protocols. One such initiative is an unprecedented set of New York State regulations implemented in June of 2013 and collectively known as “Rory's Regulations”. Named after Rory Staunton, a 12-year-old boy who died of sepsis at a New York hospital, Rory's Regulations mandate that all hospitals in the state implement evidence-based protocols for sepsis management and report data on sepsis protocol adherence and outcomes to the state government. Rory's Regulations are an innovative strategy for policy-based quality improvement in that they link traditional quality reporting with specific mandates for evidence-based practice. They are also a leading-edge forerunner to sepsis regulations in development in other states and at the national level, making it imperative that we understand their clinical and financial impact. The overall goal of this proposal is to systematically evaluate the impact of the New York state sepsis regulations. We plan a novel mixed methods approach designed to yield information that policy makers can use not only to refine the existing policy but also to design and implement future polices. First, we will use hospital emergency department and inpatient data from New York and eight control states to assess the effects of the 2013 regulations on mortality, complications of care, health care utilization and costs, controlling for case-mix and temporal trends. Second, we will complement our quantitative analyses with a theory-driven qualitative analysis in which we will perform and analyze semi-structured interviews with key stakeholders in New York State, including clinicians, policy-makers, and patient advocates. This qualitative analysis will serve to help interpret the overall policy effects and provide actionable guidance to policy makers seeking to develop similar sepsis-related regulations. Together, these aims will comprise the first rigorous evaluation of a landmark set of state-wide sepsis regulations. More broadly, they will be the first evaluation of a novel strategy for state-wide quality improvement through policy mandates for specific evidence-based practices, directly informing future efforts to improve the quality of care not only in sepsis but also in other aspects of hospital medicine.

抽象的 败血症是美国发病率和死亡率的主要原因，影响超过75万 每年的美国人每年成本超过200亿美元。几种药物已被证明 该人群的有效性，包括及时给药抗生素和早期复苏 静脉输液。但是，这些治疗方法不一致，创造了一个重​​要的 质量差距。早期认可和治疗方案可以帮助缩小这一差距并挽救生命 败血症患者，而决策者越来越多地使用法律机制来激励 使用败血症协议。这样的倡议是纽约州法规的前所未有的一套 于2013年6月实施，统称为“罗里的法规”。以罗里的名字命名 斯汤顿（Staunton）是一个12岁的男孩，在纽约一家医院死于败血症，罗里的法规要求 国家实施基于证据管理的所有医院用于败血症管理和报告 有关败血症协议遵守和结果的数据。罗里的规定是 基于政策的质量改进的创新策略，它们将传统质量报告联系起来 具有循证实践的特定任务。他们也是前沿的森林人 败血症在其他州和国家一级的发展法规，因此必须 我们了解他们的临床和财务影响。该提案的总体目标是系统地 评估纽约州败血症法规的影响。我们计划一种新颖的混合方法 旨在产生政策制定者不仅可以使用现有政策的信息的方法 还要设计和实施未来的政策。首先，我们将使用医院急诊室和 来自纽约和八个控制状态的住院数据评估2013年法规的影响 死亡率，护理并发症，医疗保健利用和成本，控制案例混合和 临时趋势。其次，我们将通过理论驱动的 定性分析我们将使用关键进行和分析半结构化访谈 纽约州的利益相关者，包括临床医生，政策制定者和患者倡导者。这 定性分析将有助于解释整体政策效果并提供可行的 寻求制定类似败血症相关法规的政策制定者的指导。这些目标在一起 将完成对一套具有里程碑意义的全州败血症法规的第一次严格评估。更多的 从广义上讲，它们将是对通过全州范围质量改进的新型策略的首次评估 对特定循证实践的政策要求，直接告知未来的努力以改善 不仅在败血症中，而且在医院医学的其他方面，护理质量。