The Return on Investment of a Province-Wide Quality Improvement Initiative for Reducing In-Hospital Sepsis Rates and Mortality in British Columbia, Canada.
Journal
Critical care medicine
ISSN: 1530-0293
Titre abrégé: Crit Care Med
Pays: United States
ID NLM: 0355501
Informations de publication
Date de publication:
01 04 2022
01 04 2022
Historique:
pubmed:
2
10
2021
medline:
16
4
2022
entrez:
1
10
2021
Statut:
ppublish
Résumé
Sepsis is a life-threatening medical emergency. There is a paucity of information on whether quality improvement approaches reduce the in-hospital sepsis caseload or save lives and decrease the healthcare system and society's cost at the provincial/national levels. This study aimed to assess the outcomes and economic impact of a province-wide quality improvement initiative in Canada. Retrospective population-based study with interrupted time series and return on investment analyses. The sepsis cases and deaths averted over time for British Columbia were calculated and compared with the rest of Canada (excluding Quebec and three territories). Aggregate data were obtained from the Canadian Institute for Health Information on risk-adjusted in-hospital sepsis rates and sepsis mortality in acute care sites across Canada. In 2012, the British Columbia Sepsis Network was formed to reduce sepsis occurrence and mortality through education, knowledge translation, and quality improvement. A return on investment analysis compared the financial investment for the British Columbia Sepsis Network with the savings from averted sepsis occurrence and mortality. An estimated 981 sepsis cases and 172 deaths were averted in the post-British Columbia Sepsis Network period (2014-2018). The total cost, including the development and implementation of British Columbia Sepsis Network, was $449,962. Net savings due to cases averted after program costs were considered were $50.6 million in 2018. This translates into a return of $112.5 for every dollar invested. British Columbia Sepsis Network appears to have averted a greater number of sepsis cases and deaths in British Columbia than the national average and yielded a positive return on investment. Our findings strengthen the policy argument for targeted quality improvement initiatives for sepsis care and provide a model of care for other provinces in Canada and elsewhere globally.
Identifiants
pubmed: 34593705
doi: 10.1097/CCM.0000000000005353
pii: 00003246-202204000-00030
pmc: PMC8923363
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
e340-e350Informations de copyright
Copyright © 2022 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the Society of Critical Care Medicine and Wolters Kluwer Health, Inc.
Déclaration de conflit d'intérêts
Dr. Khowaja received support for article research from the Michael Smith Foundation for Health Research (18164). Ms. Krause received funding from the University of British Columbia. Mr. Ridout and Ms. Kennedy disclosed they are employees of the British Columbia Patient Safety & Quality Council. Mr. Young disclosed government work. The remaining authors have disclosed that they do not have any potential conflicts of interest.
Références
Singer M, Deutschman CS, Seymour CW, et al.: The third international consensus definitions for sepsis and septic shock (Sepsis-3). JAMA 2016; 315:801–810
Angus DC, van der Poll T: Severe sepsis and septic shock. N Engl J Med 2013; 369:2063
Rudd KE, Johnson SC, Agesa KM, et al.: Global, regional, and national sepsis incidence and mortality, 1990-2017: Analysis for the Global Burden of Disease study. Lancet 2020; 395:200–211
Kelsall D, Kissoon N: Sepsis, one of CMAJ’s four new areas of focus. CMAJ 2017; 189:E1127
Chang DW, Tseng CH, Shapiro MF: Rehospitalizations following sepsis: Common and costly. Crit Care Med 2015; 43:2085–2093
Mayr FB, Talisa VB, Balakumar V, et al.: Proportion and cost of unplanned 30-day readmissions after sepsis compared with other medical conditions. JAMA 2017; 317:530–531
Prescott HC, Langa KM, Iwashyna TJ: Readmission diagnoses after hospitalization for severe sepsis and other acute medical conditions. JAMA 2015; 313:1055–1057
Herridge MS, Tansey CM, Matté A, et al.; Canadian Critical Care Trials Group: Functional disability 5 years after acute respiratory distress syndrome. N Engl J Med 2011; 364:1293–1304
Linder A, Guh D, Boyd JH, et al.: Long-term (10-year) mortality of younger previously healthy patients with severe sepsis/septic shock is worse than that of patients with nonseptic critical illness and of the general population. Crit Care Med 2014; 42:2211–2218
Linder A, Lee T, Fisher J, et al.: Short-term organ dysfunction is associated with long-term (10-yr) mortality of septic shock. Crit Care Med 2016; 44:e728–e736
Liang SY: Sepsis and other infectious disease emergencies in the elderly. Emerg Med Clin North Am 2016; 34:501–522
Rowe TA, McKoy JM: Sepsis in older adults. Infect Dis Clin North Am 2017; 31:731–742
Angus DC, Linde-Zwirble WT, Lidicker J, et al.: Epidemiology of severe sepsis in the United States: Analysis of incidence, outcome, and associated costs of care. Crit Care Med 2001; 29:1303–1310
Herridge MS, Moss M, Hough CL, et al.: Recovery and outcomes after the acute respiratory distress syndrome (ARDS) in patients and their family caregivers. Intensive Care Med 2016; 42:725–738
Rezende E, Silva JM Jr, Isola AM, et al.: Epidemiology of severe sepsis in the emergency department and difficulties in the initial assistance. Clinics (Sao Paulo) 2008; 63:457–464
Weiss SL, Peters MJ, Alhazzani W, et al.: Surviving Sepsis Campaign international guidelines for the management of septic shock and sepsis-associated organ dysfunction in children. Pediatr Crit Care Med 2020; 21:e52–e106
British Columbia Patient Safety and Quality Council: BC Sepsis Network. Available at: https://bcpsqc.ca/improve-care/bc-sepsis-network/ . Accessed September 25, 2020
Gorley C, Lindstrom RR, McKeown S, et al.: Exploring distributed leadership in the BC sepsis network. In: Healthcare Management Forum. Vol. 29. XXXLos Angeles, CA, SAGE Publications, 2016, pp 63–66
McKeown S, Krause C, Shergill M, et al.: Gamification as a strategy to engage and motivate clinicians to improve care. Healthc Manage Forum 2016; 29:67–73
Canadian Institute for Health Information: In-Hospital Sepsis. Available at: http://indicatorlibrary.cihi.ca/display/HSPIL/In-Hospital+Sepsis . Accessed September 25, 2020
Canadian Institute for Health Information: ICD-10-CA| CCI. Available at https://secure.cihi.ca/free_products/CodingStandards_v2018_EN.pdf . Accessed September 25, 2020
Statistics Canada: Deaths and Mortality Rates, by Age Group. Available at: https://www150.statcan.gc.ca/t1/tbl1/en/tv.action?pid=1310071001 . Accessed September 25, 2020
Canadian Institute for Health Information: Cost of a Standard Hospital Stay. Available at: https://yourhealthsystem.cihi.ca/hsp/inbrief?lang=en#!/indicators/015/cost-of-a-standard-hospital-stay/;mapC1;mapLevel2;/ . Accessed September 25, 2020
Lee H, Doig CJ, Ghali WA, et al.: Detailed cost analysis of care for survivors of severe sepsis. Crit Care Med 2004; 32:981–985
Priest L: How Much Does Dying Cost Canadians? The Global and Mail, 2011. Available at: https://www.theglobeandmail.com/life/health-and-fitness/how-much-does-dying-cost-canadians/article554853/ . Accessed September 25, 2020
Lee R: Burial Plots, Funeral Services and More – This Is How Much It Costs to Die in Canada. Available at: https://www.lowestrates.ca/blog/burial-plots-funeral-services-and-more-how-much-it-costs-die-canada . Accessed September 25, 2020
Afshar M, Arain E, Ye C, et al.: Patient outcomes and cost-effectiveness of a sepsis care quality improvement program in a health system. Crit Care Med 2019; 47:1371–1379
Levy MM, Evans LE, Rhodes A: The Surviving Sepsis Campaign bundle: 2018 update. Intensive Care Med 2018; 44:925–928
van Zanten AR, Brinkman S, Arbous MS, et al.; Netherlands Patient Safety Agency Sepsis Expert Group: Guideline bundles adherence and mortality in severe sepsis and septic shock. Crit Care Med 2014; 42:1890–1898
Heaton LM, Komatsu R, Low-Beer D, et al.: Estimating the number of HIV infections averted: An approach and its issues. Sex Transm Infect 2008; 84(Suppl 1):i92–i96
Canadian Agency for Drugs and Technology in Healthcare: Guidelines for the Economic Evaluation of Health Technologies: Canada (4th Edition). Available at: https://www.cadth.ca/sites/default/files/pdf/CADTH_Economic_Guidelines-3rd_vs_4th_Editions.pdf . Accessed September 25, 2020
Scheer CS, Fuchs C, Kuhn SO, et al.: Quality improvement initiative for severe sepsis and septic shock reduces 90-day mortality: A 7.5-year observational study. Crit Care Med 2017; 45:241–252
Institute for Healthcare Improvement: Severe Sepsis Bundles. Available at: http://www.ihi.org/resources/Pages/Tools/SevereSepsisBundles.aspx . Accessed September 25, 2020
Thompson MP, Reeves MJ, Bogan BL, et al.: Protocol-based resuscitation bundle to improve outcomes in septic shock patients: Evaluation of the Michigan Health and Hospital Association keystone sepsis collaborative. Crit Care Med 2016; 44:2123–2130
Machado FR, Ferreira EM, Sousa JL, et al.; Latin American Sepsis Institute Network: Quality improvement initiatives in sepsis in an emerging country: Does the institution’s main source of income influence the results? An analysis of 21,103 patients. Crit Care Med 2017; 45:1650–1659
University of Calgary: Alberta Sepsis Network. Available at: https://www.ucalgary.ca/albertasepsisnetwork/ . Accessed September 25, 2020
University of Manitoba: Translating Emergency Knowledge for Kids – TREKK. Available at: https://www.nce-rce.gc.ca/NetworksCentres-CentresReseaux/NCEKM-RCEMC/TREKK-TRACE_eng.asp . Accessed September 25, 2020
Canadian Patient Safety Institute: Infection Prevention and Control (IPAC). Available at: https://www.patientsafetyinstitute.ca/en/Topic/Pages/Infection-Prevention-and-Control.aspx . Accessed September 25, 2020
British Columbia Patient Safety and Quality Council: Type 2 Diabetes Network. Available at: https://bcpsqc.ca/improve-care/diabetes-network/ . Accessed September 25, 2020
British Columbia Patient Safety and Quality Council: Surgical Quality Action Network. Available: https://bcpsqc.ca/improve-care/surgical-improvement/sqan/ . Accessed September 25, 2020
Centers for Disease Control and Prevention: Catheter-Associated Urinary Tract Infection (CAUTI). Available: https://www.cdc.gov/hai/ca_uti/uti.html . Accessed September 25, 2020
British Columbia Patient Safety and Quality Council: National Surgical Quality Improvement Program. Available at: https://bcpsqc.ca/improve-care/surgical-improvement/national-surgical-quality-improvement-program/ . Accessed September 25, 2020
Muscedere J, Dodek P, Keenan S, et al.; VAP Guidelines Committee and the Canadian Critical Care Trials Group: Comprehensive evidence-based clinical practice guidelines for ventilator-associated pneumonia: Prevention. J Crit Care 2008; 23:126–137
Kaukonen KM, Bailey M, Suzuki S, et al.: Mortality related to severe sepsis and septic shock among critically ill patients in Australia and New Zealand, 2000-2012. JAMA 2014; 311:1308–1316
Seymour CW, Gesten F, Prescott HC, et al.: Time to treatment and mortality during mandated emergency care for sepsis. N Engl J Med 2017; 376:2235–2244