Improving Morbidity During Post-Acute Care Transitions for Sepsis (IMPACTS)
Primary Purpose
Clinical Sepsis
Status
Completed
Phase
Not Applicable
Locations
United States
Study Type
Interventional
Intervention
Sepsis Transition And Recovery (STAR)
Usual care
Sponsored by
About this trial
This is an interventional health services research trial for Clinical Sepsis focused on measuring evidence based medicine, continuity of patient care, patient navigator, health services, pragmatic clinical trial
Eligibility Criteria
Inclusion Criteria:
- Admitted from the emergency department to inpatient or observation status at one of: Carolinas Medical Center, Carolinas Medical Center - Mercy, or Atrium Health Northeast;
- ≥18 years of age upon admission;
oral/parenteral antibiotic or bacterial culture order within 24 hours of emergency department presentation and
- culture drawn first, antibiotics ordered within 48 hours or
- antibiotics ordered first, culture ordered within 48 hours (adapted from criteria applied in development of the Third International Consensus Definitions for Sepsis and Septic Shock)
- deemed as high-risk for 30-day readmission (i.e., ≥ 20%) or 30-day mortality (i.e., ≥ 10%) using risk-scoring models
- not discharged at the time of patient list generation
Exclusion Criteria:
- prior randomization to either STAR or usual care study arms;
- not a North Carolina resident or residence >2.5-hour drive time from treating hospital;
- the only antibiotic associated with patient is administered in the operating room as this likely represents pre-operative infection prophylaxis and not presumed infection;
- patients transferred from other acute care hospitals;
- patients with a change in code status (i.e., do not resuscitate, do not intubate) within 24 hours after admission due to the general assumption of increased risk of exposure to less aggressive treatment;
- patients with infection ruled out during the index hospitalization.
Sites / Locations
- Atrium Health
Arms of the Study
Arm 1
Arm 2
Arm Type
Experimental
Active Comparator
Arm Label
Sepsis Transition And Recovery (STAR)
Usual Care
Arm Description
Virtual sepsis navigation delivered across the peri-hospital discharge interval
Patients and their providers will have no access to the STAR program. Aspects of usual care will be determined by treating clinicians independent of trial assignment.
Outcomes
Primary Outcome Measures
Combined all-cause mortality or unplanned hospital readmission
Hospital readmission will be captured from healthcare utilization data in the Atrium Health enterprise data warehouse. Index visit is defined by the Centers for Medicaid and Medicare Services (CMS) with additional inclusion of observation patients at any Atrium Health facility. Vital status verification data is ascertained via monthly Social Security Administration Limited Access Death Master File (DMF) data feed and validated record linkage process into the Atrium Health data warehouse. For the composite primary outcome, we will capture all patients with either date of death or eligible hospital readmission prior to 30 days post discharge as event-positive.
Secondary Outcome Measures
All-cause mortality
Death inside or outside of the hospital ascertained via monthly Social Security Administration Limited Access Death Master File (DMF) data feed and validated record linkage process into the Atrium Health data warehouse.
All-cause mortality
Death inside or outside of the hospital ascertained via monthly Social Security Administration Limited Access Death Master File (DMF) data feed and validated record linkage process into the Atrium Health data warehouse.
All-cause unplanned hospital readmission
Hospital readmission will be captured from any Atrium Health facility. Index visit is defined by the Centers for Medicaid and Medicare Services (CMS) with additional inclusion of observation patients at any Atrium Health facility.
All-cause unplanned hospital readmission
Hospital readmission will be captured from any Atrium Health facility. Index visit is defined by the Centers for Medicaid and Medicare Services (CMS) with additional inclusion of observation patients at any Atrium Health facility.
Infection-related unplanned hospital readmission
Hospital readmission with infection-related primary discharge diagnosis will be captured from any Atrium Health facility. Index visit is defined by the Centers for Medicaid and Medicare Services (CMS) with additional inclusion of observation patients at any Atrium Health facility.
Infection-related unplanned hospital readmission
Hospital readmission with infection-related primary discharge diagnosis will be captured from any Atrium Health facility. Index visit is defined by the Centers for Medicaid and Medicare Services (CMS) with additional inclusion of observation patients at any Atrium Health facility.
Chronic lung disease-related unplanned hospital readmission
Hospital readmission with chronic lung disease-related primary discharge diagnosis will be captured from any Atrium Health facility. Index visit is defined by the Centers for Medicaid and Medicare Services (CMS) with additional inclusion of observation patients at any Atrium Health facility.
Chronic lung disease-related unplanned hospital readmission
Hospital readmission with chronic lung disease-related primary discharge diagnosis will be captured from any Atrium Health facility. Index visit is defined by the Centers for Medicaid and Medicare Services (CMS) with additional inclusion of observation patients at any Atrium Health facility.
Heart failure-related unplanned hospital readmission
Hospital readmission with heart failure-related primary discharge diagnosis will be captured from any Atrium Health facility. Index visit is defined by the Centers for Medicaid and Medicare Services (CMS) with additional inclusion of observation patients at any Atrium Health facility.
Heart failure-related unplanned hospital readmission
Hospital readmission with heart failure-related primary discharge diagnosis will be captured from any Atrium Health facility. Index visit is defined by the Centers for Medicaid and Medicare Services (CMS) with additional inclusion of observation patients at any Atrium Health facility.
Acute kidney injury-related unplanned hospital readmission
Hospital readmission with acute kidney injury-related primary discharge diagnosis will be captured from any Atrium Health facility. Index visit is defined by the Centers for Medicaid and Medicare Services (CMS) with additional inclusion of observation patients at any Atrium Health facility.
Acute kidney injury-related unplanned hospital readmission
Hospital readmission with acute kidney injury-related primary discharge diagnosis will be captured from any Atrium Health facility. Index visit is defined by the Centers for Medicaid and Medicare Services (CMS) with additional inclusion of observation patients at any Atrium Health facility.
All-cause emergency department visits
Emergency department visits to any Atrium Health facility
All-cause emergency department visits
Emergency department visits to any Atrium Health facility
Acute care costs
Costs attributed to acute care received at any Atrium Health emergency department, observation, or inpatient hospital encounter
Acute care costs
Costs attributed to acute care received at any Atrium Health emergency department, observation, or inpatient hospital encounter
Total healthcare costs
Costs attributed to healthcare claims incurred at any Atrium Health or outside system facility (only in the subgroup of patients enrolled in a Medicare Shared Savings Plan)
Total healthcare costs
Costs attributed to healthcare claims incurred at any Atrium Health or outside system facility (only in the subgroup of patients enrolled in a Medicare Shared Savings Plan)
Acute care-free days alive
The sum of days alive without inpatient, observation, and emergency department encounters at any Atrium Health facility (rounded to full day for any day with acute care utilization) during the interval after discharge
Acute care-free days alive
The sum of days alive without inpatient, observation, and emergency department encounters at any Atrium Health facility (rounded to full day for any day with acute care utilization) during the interval after discharge
Full Information
NCT ID
NCT03865602
First Posted
March 5, 2019
Last Updated
April 19, 2022
Sponsor
Wake Forest University Health Sciences
1. Study Identification
Unique Protocol Identification Number
NCT03865602
Brief Title
Improving Morbidity During Post-Acute Care Transitions for Sepsis
Acronym
IMPACTS
Official Title
Improving Morbidity During Post-Acute Care Transitions for Sepsis (IMPACTS): A Pragmatic Randomized Evaluation of Implementing Best Practice Care for Sepsis Survivors to Reduce Morbidity and Mortality
Study Type
Interventional
2. Study Status
Record Verification Date
March 2022
Overall Recruitment Status
Completed
Study Start Date
January 29, 2019 (Actual)
Primary Completion Date
December 31, 2020 (Actual)
Study Completion Date
December 31, 2021 (Actual)
3. Sponsor/Collaborators
Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Wake Forest University Health Sciences
4. Oversight
Studies a U.S. FDA-regulated Drug Product
No
Studies a U.S. FDA-regulated Device Product
No
Data Monitoring Committee
No
5. Study Description
Brief Summary
The purpose of this study is to improve transitions of care for the highest risk, complex patients with suspected sepsis. Atrium Health has developed a nurse-navigator facilitated care transition strategy, called the Sepsis Transition and Recovery (STAR) program, to improve the implementation of recommended care practices and bridge care gaps for patients in the post-sepsis transition period. During their hospitalization, STAR program patients enter into a transition pathway facilitated by a centrally located nurse navigator and including the following evidence-based post-sepsis care components: i) review and recommendation for adjustment of medications; ii) identification of and referral for new physical, mental, and cognitive deficits; iii) surveillance for treatable conditions that commonly lead to poor outcomes; and iv) referral to palliative care when appropriate. IMPACTS (Improving Morbidity during Post-Acute Care Transitions for Sepsis) is a pragmatic, randomized program evaluation to compare clinical outcomes between sepsis survivors who receive usual care versus care delivered through the STAR program following hospitalization. IMPACTS will test the hypothesis that patients that receive care through STAR will have decreased composite all cause, 30-day hospital readmission and mortality compared to patients that receive usual care.
Detailed Description
BACKGROUND
Sepsis is a common and life-threatening condition defined by organ dysfunction due to a dysregulated response to infection (Fleischmann, 2016). Aggressive early sepsis identification and treatment initiatives have decreased hospital mortality for patients with sepsis (Rhodes, 2017). As mortality rates have improved, there has been a growing recognition of the downstream effects of sepsis for the approximately 14 million annual sepsis survivors who encounter increased long-term mortality and morbidity across functional, cognitive, and psychological domains (Iwashyna, 2010; Shah, 2013; Schuler, 2018; Borges, 2015; Annane, 2015; Prescott, 2015). Currently, there is a disconnect between the post-acute care needs of sepsis survivors and the resources available to these patients (Huang, 2016; Ortego, 2015; Winters, 2010; Nesseler, 2013). Inadequate post-sepsis care strategies are reflected by adverse outcomes post-sepsis including increased mortality risk and strikingly high rates of healthcare utilization, including a 90-day hospital readmission rate of 40% and over 3 billion dollars in preventable costs (Prescott, 2016; Goodwin, 2015; Prescott, 2014; Jones, 2015). To address the specific gaps in treatment for sepsis survivors, international experts developed best-practice recommendations to guide delivery of post-sepsis care (Prescott, 2018). These best-practice recommendations are directed towards the specific challenges and sequelae following a sepsis hospitalization and include: i) identification and treatment of new physical, mental, and cognitive deficits; ii) review and adjustment of medications; iii) surveillance of treatable conditions that commonly lead to poor outcomes; and iv) focus on palliative care when appropriate. However, implementation of recommended post-sepsis practices is hindered by a gap in understanding how to best integrate interventions into the complex and fragmented post discharge setting (e.g., lack of provider time and patient engagement, limited access to care management, and insufficient institutional support) (Taylor, 2019; Brownson, 2012; Bodenheimer, 2008; Coleman, 2004).
RATIONALE
In randomized controlled trials (RCTs), including our previous work, successfully implemented care transition programs using nurse navigators have been shown to reduce hospital readmissions and costs. To better enhance transitions of care for the highest risk, complex patients with suspected sepsis, we propose extending this evidence using a nurse-facilitated care transition program for patients in the post-sepsis transition period to improve the implementation of recommended care practices and bridge care gaps. This approach, called the Sepsis Transition and Recovery (STAR) program, is the next step in the progression of our group's work on improving discharge transitions and sepsis processes of care. A key aspect of this initiative includes the ability to identify sepsis survivors at the greatest risk for poor outcomes. For example, one-quarter of sepsis survivors account for three-quarters of hospital readmissions and costs, indicating that identifying high-risk sepsis patients for targeted facilitation of best-practice care could efficiently impact quality and cost.
Our STAR program uses near real-time risk modeling to identify high-risk patients and a centrally located nurse, virtually connected to participating hospitals, to coordinate the application of evidence-based recommendations for post-sepsis care, overcome barriers to recommended care, and bridge gaps in service that can serve as points of failure for complex patients. During their hospitalization, high-risk patients enter into a transition pathway integrated within Atrium Health Hospital Medicine's Transition Services program and includes the following core components: i) Introduction to STAR process prior to discharge (confirm provider consults e.g., PT, ID, palliative); ii) Disease-specific education and discharge "playbook"; iii) Virtual hospital follow-up evaluation within 48 hours including medication reconciliation; iv) Second, post-acute virtual follow-up within 72 hours (symptom monitoring, confirm provider follow-up); v) Weekly contact with care management team; vi) Referral to provider follow-up (e.g., primary care provider, transition clinic) as appropriate; vii) Coordinated transition to the next appropriate care location after 30 days from time of discharge. The STAR navigator also meets weekly with the Medical Director of the Atrium Health Transition Services program who provides additional clinical oversight of ongoing cases.
The IMPACTS (Improving Morbidity during Post Acute Care Transitions for Sepsis) evaluation will examine if implementation of the STAR program within a large healthcare system will improve outcomes for high-risk sepsis patients. This randomized program evaluation is designed to be a seamless part of routine care in a real-world setting to generate knowledge of best practices for implementation and dissemination of post-sepsis transitions of care.
INVESTIGATIONAL PLAN
Overall Study Design
This real-world pragmatic randomized program evaluation will compare the effectiveness of the Sepsis Transition And Recovery (STAR) program versus usual care on post-sepsis care and patient outcomes. The STAR program is informed by existing evidence and designed using the Chronic Care Model to increase best-practice adherence and care coordination, resulting in improved transitions between hospitals and post-acute care during sepsis recovery.
Because of resource limitations, STAR can only be made available to a limited number of patients. To be objective in patient selection and allow for program evaluation, we will use a data driven approach to identify patients as eligible for program referral. First, risk modeling will identify patients as high risk for 30-day readmission or 30-day mortality during the first day of the hospital admission. Then from this pool of high-risk patients, up to 6 patients will be randomly selected each weekday to be referred to either receive usual care or care delivered through the STAR program. The number of daily patients to be randomized was selected to match targeted capacity for the STAR navigator and will be reevaluated on a biweekly basis. Because variables that affect eligibility may change during a hospital stay, initial eligibility will be re-confirmed at time of hospital discharge. Specifically, patients who have had infection diagnosis ruled-out during their hospitalization (i.e., rule-out documented in medical record) will be excluded for the purposes of analysis. All remaining eligible patients at the time of discharge will be included in analyses, which will be conducted using an intent-to-treat approach. Planned enrollment is 708 patients (n=354 patients per study arm) and STAR program follow-up will be completed 30 days after hospital discharge. Outcomes data will be tracked for 90 days and captured from routinely collected data from the Atrium Health Enterprise Data Warehouse. Given this evaluation protocol is part of a quality improvement intervention that relies on using evidence-based interventions, only utilizes data collected as part of routine care, and is minimal risk to patients, we requested that the institutional review board designate this study as expedited research and grant a waiver of informed consent.
Primary Outcome Variable The primary outcome is a composite, dichotomous endpoint of all-cause mortality or unplanned hospital readmission assessed 30 days post index hospital discharge.
Secondary Outcome Variable(s)
all-cause 30- and 90-day mortality;
all-cause 30- and 90-day hospital readmission;
30- and 90-day cause-specific hospital readmissions with primary diagnoses related to: a) infection, b) chronic lung disease, c) heart failure, and d) acute kidney injury;
30- and 90-day emergency department visits;
30- and 90-day acute-care costs;
30- and 90-day total healthcare costs (only in the subgroup of patients enrolled in a Medicare Shared Savings Plan);
acute care-free days alive measured at 30 and 90 days, defined as the sum of days alive without inpatient, observation, and emergency department encounters (rounded to full day for any day with acute care utilization) during the interval after discharge.
Subject Selection Subject selection will occur via an automated query process for patient list generation. Each weekday morning actively admitted patients at 3 study hospitals (i.e., Carolinas Medical Center, Carolinas Medical Center - Mercy, and Atrium Health Northeast) will be identified from the electronic health record and Enterprise Data Warehouse and output into daily eligibility lists based on the study's inclusion/exclusion criteria.
Randomization Eligible patients will be randomly allocated 1:1 to receive usual care or the STAR program. Clinicians and patients are not blinded to treatment allocation. Due to resource limitations, STAR will only be made available to a limited number of patients. Thus, a constrained randomization scheme will be utilized to randomly allocate up to six eligible patients to either STAR or usual care each weekday. The number of patients allocated to be randomized daily was selected to match targeted capacity for the STAR navigators and will be reevaluated on a biweekly basis and adjusted as needed.
6. Conditions and Keywords
Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Clinical Sepsis
Keywords
evidence based medicine, continuity of patient care, patient navigator, health services, pragmatic clinical trial
7. Study Design
Primary Purpose
Health Services Research
Study Phase
Not Applicable
Interventional Study Model
Parallel Assignment
Masking
None (Open Label)
Allocation
Randomized
Enrollment
712 (Actual)
8. Arms, Groups, and Interventions
Arm Title
Sepsis Transition And Recovery (STAR)
Arm Type
Experimental
Arm Description
Virtual sepsis navigation delivered across the peri-hospital discharge interval
Arm Title
Usual Care
Arm Type
Active Comparator
Arm Description
Patients and their providers will have no access to the STAR program. Aspects of usual care will be determined by treating clinicians independent of trial assignment.
Intervention Type
Behavioral
Intervention Name(s)
Sepsis Transition And Recovery (STAR)
Intervention Description
In the STAR program intervention, a centrally located nurse navigator facilitates the application of four evidence-based core components of post-sepsis care (i.e., review of medications, new impairments, comorbidities, and palliative care) to patients prior to and during the 30 days after hospital discharge. The STAR navigator will provide telephone and EHR-based support within the hospitalization and to patients across all discharge settings with remote monitoring at specified intervals following hospital discharge. Patients will continue to receive STAR directed services for 30 days following their discharge and then will be transitioned back to the next appropriate care location.
Intervention Type
Behavioral
Intervention Name(s)
Usual care
Intervention Description
Patients and their providers will not have access to the STAR program. Patients will continue to receive usual care throughout their stay and discharge, consisting of: patient education and follow-up instructions at discharge, which are not specific to sepsis; routine recommendations for follow-up visits with primary care providers; arrangements for home health services or care management follow-up based on each patient's needs but not specifically tailored to the sepsis population; discharge to post-acute setting with no sepsis-specific follow-up. All aspects of usual care will be determined by treating clinicians independent of trial assignment.
Primary Outcome Measure Information:
Title
Combined all-cause mortality or unplanned hospital readmission
Description
Hospital readmission will be captured from healthcare utilization data in the Atrium Health enterprise data warehouse. Index visit is defined by the Centers for Medicaid and Medicare Services (CMS) with additional inclusion of observation patients at any Atrium Health facility. Vital status verification data is ascertained via monthly Social Security Administration Limited Access Death Master File (DMF) data feed and validated record linkage process into the Atrium Health data warehouse. For the composite primary outcome, we will capture all patients with either date of death or eligible hospital readmission prior to 30 days post discharge as event-positive.
Time Frame
30 days from index visit
Secondary Outcome Measure Information:
Title
All-cause mortality
Description
Death inside or outside of the hospital ascertained via monthly Social Security Administration Limited Access Death Master File (DMF) data feed and validated record linkage process into the Atrium Health data warehouse.
Time Frame
30 days from index visit
Title
All-cause mortality
Description
Death inside or outside of the hospital ascertained via monthly Social Security Administration Limited Access Death Master File (DMF) data feed and validated record linkage process into the Atrium Health data warehouse.
Time Frame
90 days from index visit
Title
All-cause unplanned hospital readmission
Description
Hospital readmission will be captured from any Atrium Health facility. Index visit is defined by the Centers for Medicaid and Medicare Services (CMS) with additional inclusion of observation patients at any Atrium Health facility.
Time Frame
30 days from index visit
Title
All-cause unplanned hospital readmission
Description
Hospital readmission will be captured from any Atrium Health facility. Index visit is defined by the Centers for Medicaid and Medicare Services (CMS) with additional inclusion of observation patients at any Atrium Health facility.
Time Frame
90 days from index visit
Title
Infection-related unplanned hospital readmission
Description
Hospital readmission with infection-related primary discharge diagnosis will be captured from any Atrium Health facility. Index visit is defined by the Centers for Medicaid and Medicare Services (CMS) with additional inclusion of observation patients at any Atrium Health facility.
Time Frame
30 days from index visit
Title
Infection-related unplanned hospital readmission
Description
Hospital readmission with infection-related primary discharge diagnosis will be captured from any Atrium Health facility. Index visit is defined by the Centers for Medicaid and Medicare Services (CMS) with additional inclusion of observation patients at any Atrium Health facility.
Time Frame
90 days from index visit
Title
Chronic lung disease-related unplanned hospital readmission
Description
Hospital readmission with chronic lung disease-related primary discharge diagnosis will be captured from any Atrium Health facility. Index visit is defined by the Centers for Medicaid and Medicare Services (CMS) with additional inclusion of observation patients at any Atrium Health facility.
Time Frame
30 days from index visit
Title
Chronic lung disease-related unplanned hospital readmission
Description
Hospital readmission with chronic lung disease-related primary discharge diagnosis will be captured from any Atrium Health facility. Index visit is defined by the Centers for Medicaid and Medicare Services (CMS) with additional inclusion of observation patients at any Atrium Health facility.
Time Frame
90 days from index visit
Title
Heart failure-related unplanned hospital readmission
Description
Hospital readmission with heart failure-related primary discharge diagnosis will be captured from any Atrium Health facility. Index visit is defined by the Centers for Medicaid and Medicare Services (CMS) with additional inclusion of observation patients at any Atrium Health facility.
Time Frame
30 days from index visit
Title
Heart failure-related unplanned hospital readmission
Description
Hospital readmission with heart failure-related primary discharge diagnosis will be captured from any Atrium Health facility. Index visit is defined by the Centers for Medicaid and Medicare Services (CMS) with additional inclusion of observation patients at any Atrium Health facility.
Time Frame
90 days from index visit
Title
Acute kidney injury-related unplanned hospital readmission
Description
Hospital readmission with acute kidney injury-related primary discharge diagnosis will be captured from any Atrium Health facility. Index visit is defined by the Centers for Medicaid and Medicare Services (CMS) with additional inclusion of observation patients at any Atrium Health facility.
Time Frame
30 days from index visit
Title
Acute kidney injury-related unplanned hospital readmission
Description
Hospital readmission with acute kidney injury-related primary discharge diagnosis will be captured from any Atrium Health facility. Index visit is defined by the Centers for Medicaid and Medicare Services (CMS) with additional inclusion of observation patients at any Atrium Health facility.
Time Frame
90 days from index visit
Title
All-cause emergency department visits
Description
Emergency department visits to any Atrium Health facility
Time Frame
30 days from index visit
Title
All-cause emergency department visits
Description
Emergency department visits to any Atrium Health facility
Time Frame
90 days from index visit
Title
Acute care costs
Description
Costs attributed to acute care received at any Atrium Health emergency department, observation, or inpatient hospital encounter
Time Frame
30 days from index visit
Title
Acute care costs
Description
Costs attributed to acute care received at any Atrium Health emergency department, observation, or inpatient hospital encounter
Time Frame
90 days from index visit
Title
Total healthcare costs
Description
Costs attributed to healthcare claims incurred at any Atrium Health or outside system facility (only in the subgroup of patients enrolled in a Medicare Shared Savings Plan)
Time Frame
30 days from index visit
Title
Total healthcare costs
Description
Costs attributed to healthcare claims incurred at any Atrium Health or outside system facility (only in the subgroup of patients enrolled in a Medicare Shared Savings Plan)
Time Frame
90 days from index visit
Title
Acute care-free days alive
Description
The sum of days alive without inpatient, observation, and emergency department encounters at any Atrium Health facility (rounded to full day for any day with acute care utilization) during the interval after discharge
Time Frame
30 days from index visit
Title
Acute care-free days alive
Description
The sum of days alive without inpatient, observation, and emergency department encounters at any Atrium Health facility (rounded to full day for any day with acute care utilization) during the interval after discharge
Time Frame
90 days from index visit
10. Eligibility
Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria:
Admitted from the emergency department to inpatient or observation status at one of: Carolinas Medical Center, Carolinas Medical Center - Mercy, or Atrium Health Northeast;
≥18 years of age upon admission;
oral/parenteral antibiotic or bacterial culture order within 24 hours of emergency department presentation and
culture drawn first, antibiotics ordered within 48 hours or
antibiotics ordered first, culture ordered within 48 hours (adapted from criteria applied in development of the Third International Consensus Definitions for Sepsis and Septic Shock)
deemed as high-risk for 30-day readmission (i.e., ≥ 20%) or 30-day mortality (i.e., ≥ 10%) using risk-scoring models
not discharged at the time of patient list generation
Exclusion Criteria:
prior randomization to either STAR or usual care study arms;
not a North Carolina resident or residence >2.5-hour drive time from treating hospital;
the only antibiotic associated with patient is administered in the operating room as this likely represents pre-operative infection prophylaxis and not presumed infection;
patients transferred from other acute care hospitals;
patients with a change in code status (i.e., do not resuscitate, do not intubate) within 24 hours after admission due to the general assumption of increased risk of exposure to less aggressive treatment;
patients with infection ruled out during the index hospitalization.
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Marc Kowalkowski, PhD
Organizational Affiliation
Wake Forest University Health Sciences
Official's Role
Principal Investigator
First Name & Middle Initial & Last Name & Degree
Stephanie P Taylor, MD
Organizational Affiliation
Wake Forest University Health Sciences
Official's Role
Principal Investigator
Facility Information:
Facility Name
Atrium Health
City
Charlotte
State/Province
North Carolina
ZIP/Postal Code
28203
Country
United States
12. IPD Sharing Statement
Plan to Share IPD
No
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Improving Morbidity During Post-Acute Care Transitions for Sepsis
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