Sepsis Order Set Use Associated With Increased Care Value.

Autor:	Dale CR; Providence Swedish, Seattle, WA; University of Washington, Seattle, WA. Electronic address: Christopher.dale@swedish.org., Chiu ST; Providence Center for Cardiovascular Analytics, Research and Data Science, Portland, OR., Schoepflin Sanders S; Providence St. Vincent Medical Center, Portland, OR., Stowell CJ; Providence Research Network, Renton., Steel TL; Pulmonary, Critical Care and Sleep Medicine, University of Washington, Seattle, WA., Liao JM; Department of Medicine, University of Washington, Seattle, WA., Barnes JI; Department of Medicine, University of Washington, Seattle, WA.
Jazyk:	angličtina
Zdroj:	Chest [Chest] 2024 Nov; Vol. 166 (5), pp. 1046-1055. Date of Electronic Publication: 2024 Jun 19.
DOI:	10.1016/j.chest.2024.05.032
Abstrakt:	Background: Sepsis is common and expensive, and evidence suggests that sepsis order sets may help to improve care. Very incomplete evidence exists regarding the effects of sepsis order sets on the value of care produced by hospitals or the societal costs of sepsis care. Research Question: In patients hospitalized for sepsis, is the receipt a of a sepsis order set vs no order set associated with improved value of care, defined as decreased hospital mortality, decreased hospital direct variable costs, and decreased societal spending on hospitalizations? Study Design and Methods: This retrospective cohort study included patients discharged with sepsis International Classification of Diseases, Tenth Revision, codes over 2 years from a large integrated delivery system. Using a propensity score, sepsis order set users were matched to nonusers to study the association between sepsis order set use and the value of care from the hospital and societal perspective. The association between order set receipt and hospital mortality, direct variable cost, and hospital revenue also were examined in a priori defined subgroups of sepsis severity and hospital mortality. Results: The study included 97,249 patients, with 52,793 patients (54%) receiving the sepsis order set. The propensity score match analysis included 55,542 patients, with 27,771 patients in each group. Recipients of the sepsis order set showed a 3.3% lower hospital mortality rate and a $1,487 lower median direct variable total cost (P < .01 for both). Median payer-neutral reimbursement (ie, PNR), a proxy for hospital revenue and thus societal costs, was $465 lower for sepsis order set users (P < .01). Receipt of the sepsis order set was associated with a $1,022 increase in contribution margin, the difference between direct variable costs and PNR per patient. Interpretation: Receipt of the sepsis order set was associated with improved value of care, from both a hospital and societal perspective. Competing Interests: Financial/Nonfinancial Disclosures None declared. (Copyright © 2024 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.)
Databáze:	MEDLINE
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