The German Quality Network Sepsis: Evaluation of a Quality Collaborative on Decreasing Sepsis-Related Mortality in a Controlled Interrupted Time Series Analysis

Frontiers in Medicine

Torsten Schreiber¹  Daniel O. Thomas-Rüddel²  Konrad Reinhart³  Hendrik Rüddel⁴  Michael Glas⁵  Alexander Brinkmann⁶  Patrick Meybohm⁷  Matthias Gründling⁸  Carolin Fleischmann-Struzek⁹  Mathias W. Pletz⁹  Daniel Schwarzkopf⁹  Marcus E. Friedrich^1,11  Christian Gogoll^1,12 

[1] 0Department of Anesthesia and Intensive Care, Zentralklinik Bad Berka, Bad Berka, Germany;1Berlin Institute of Health, Campus Virchow-Klinikum, Berlin, Germany;2Department of Anesthesiology and Operative Intensive Care Medicine (CCM, CVK), Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany;Department for Anesthesiology and Intensive Care Medicine, Jena University Hospital, Jena, Germany;Department for Infectious Diseases and Infection Control, KH Labor GmbH, AMEOS Group, Bernburg, Germany;Department of Anesthesiology and Intensive Care Medicine, General Hospital of Heidenheim, Heidenheim, Germany;Department of Anesthesiology, Intensive Care, Emergency and Pain Medicine, University Hospital Wuerzburg, Wuerzburg, Germany;Department of Anesthesiology, University Hospital of Greifswald, Greifswald, Germany;Institute for Infectious Diseases and Infection Control, Jena University Hospital, Jena, Germany;Integrated Research and Treatment Center for Sepsis Control and Care (CSCC), Jena University Hospital, Jena, Germany;New York State Department of Health, Albany, NY, United States;Outpatient Services, Evangelische Lungenklinik Berlin-Buch, Berlin, Germany;

关键词: sepsis;    mortality;    quality improvement;    risk adjustment;    administrative claims;    interdisciplinary health team;   

DOI  :  10.3389/fmed.2022.882340

来源: DOAJ

【 摘 要 】

BackgroundSepsis is one of the leading causes of preventable deaths in hospitals. This study presents the evaluation of a quality collaborative, which aimed to decrease sepsis-related hospital mortality.MethodsThe German Quality Network Sepsis (GQNS) offers quality reporting based on claims data, peer reviews, and support for establishing continuous quality management and staff education. This study evaluates the effects of participating in the GQNS during the intervention period (April 2016–June 2018) in comparison to a retrospective baseline (January 2014–March 2016). The primary outcome was all-cause risk-adjusted hospital mortality among cases with sepsis. Sepsis was identified by International Classification of Diseases (ICD) codes in claims data. A controlled time series analysis was conducted to analyze changes from the baseline to the intervention period comparing GQNS hospitals with the population of all German hospitals assessed via the national diagnosis-related groups (DRGs)-statistics. Tests were conducted using piecewise hierarchical models. Implementation processes and barriers were assessed by surveys of local leaders of quality improvement teams.ResultsSeventy-four hospitals participated, of which 17 were university hospitals and 18 were tertiary care facilities. Observed mortality was 43.5% during baseline period and 42.7% during intervention period. Interrupted time-series analyses did not show effects on course or level of risk-adjusted mortality of cases with sepsis compared to the national DRG-statistics after the beginning of the intervention period (p = 0.632 and p = 0.512, respectively). There was no significant mortality decrease in the subgroups of patients with septic shock or ventilation >24 h or predefined subgroups of hospitals. A standardized survey among 49 local quality improvement leaders in autumn of 2018 revealed that most hospitals did not succeed in implementing a continuous quality management program or relevant measures to improve early recognition and treatment of sepsis. Barriers perceived most commonly were lack of time (77.6%), staff shortage (59.2%), and lack of participation of relevant departments (38.8%).ConclusionAs long as hospital-wide sepsis quality improvement efforts will not become a high priority for the hospital leadership by assuring adequate resources and involvement of all pertinent stakeholders, voluntary initiatives to improve the quality of sepsis care will remain prone to failure.

【 授权许可】

Unknown