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Care Variation in Treatment of Sepsis

Diagnosis of sepsis and treatment modalities for severe sepsis and septic shock across care settings highlight variation in care leading to poor clinical quality and cost outcomes.

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Care Variation in Treatment of Sepsis

  1. 1. © 2017 Indegene. All rights reserved. Care Variation in Treatment of Sepsis
  2. 2. © 2017 Indegene. All rights reserved. LOREM IPSUM DOLOR ISMET More than a million people in the United States suffer from severe sepsis every year1 and 28% to 50% of these people die2 . The Variation Challenge - Deviation from the Best Practices in Treatment of Sepsis Sepsis accounts for a higher number of cases of 30-day hospital readmissions than the 4 other medical conditions, namely, acute myocardial infarction (AMI), heart failure, chronic obstructive pulmonary disease (COPD), and pneumonia,3 each of which is tracked by the Centers for Medicare & Medicaid Services (CMS) to measure quality of care delivered and ascertain pay-for-performance reimbursements. Sepsis was also the most expensive condition treated, accounting for $23.7 billion of the aggregate hospital costs4 as physicians generously prescribed antibiotics to the affected patient without a thorough diagnosis, driven by traditional financial incentives. With diagnosis and treatment modalities varying across care settings, sepsis definitely demands our attention. Variation Reduction Scaffold The following three-step process lays the framework to deliver better patient-centered outcomes while optimizing the costs of treatment, without unwarranted use of resources or additional harm done through deviations from standardized protocols. (1) Use a data-driven approach to identify physicians across care settings who are contributing to the highest utilization of services and whose patients' health has deteriorated moving progressively from sepsis to either severe sepsis or even septic shock. This would help unearth key drivers of variation at both the organization level, that is, whether variation in care is more often witnessed at a community hospital or a medical center, and at the level of individual providers. (2) Initiate physician education sessions that can be accessed online seamlessly. Behavior change in physicians is driven by aligning data and evidence-based guidelines relevant to their practice with customized feedback. For example, look out for supporting clinical markers, including complex interplays between comorbidities (especially chronic conditions) and individual health characteristics/genetics in blood culture reports, before prescribing antibiotics. This aspect of care is overlooked quite often and improves the confidence in diagnosing the condition at the onset of the disease. Another example is to provide education to improve outcomes such as length-of-stay (LOS) in both, the Intensive Care Unit (ICU) and the Emergency Department (ED). The LOS could be reduced by adhering to defined treatment protocols for resuscitation, vasopressor regimens, hemodynamic monitoring, and for other factors. (3) Measure outcomes and processes on a continuous basis because what cannot be measured, cannot be improved. Engagement initiatives should translate to quantifiable clinical, utilization, and overall cost Care Variation in Treatment of Sepsis
  3. 3. © 2017 Indegene. All rights reserved. outcomes. For example, the targeted providers must show lower LOS for the treated patient population, which could then translate to potential cost savings for an episode of sepsis. The key takeaway is to modify physician behaviour that warrants an aggressive and time-bound step-by- step approach in treating the patient. Variation IQ Can Help We can help you understand your episodes of care using your cost and clinical data, unearth the improvement opportunities, engage your physicians, and deliver practice change. We look forward to opportunities to apply Variation IQ tools and processes to enhance the healthcare of your patients while improving your operational efficiency and margins. References 1. Hall MJ, Williams SN, DeFrances CJ, Golosinskiy A. Inpatient care for septicemia or sepsis: a challenge for patients and hospitals. National Center for Health Statistics Data Brief. 2011;62:1-8. 2. Wood KA, Angus DC. Pharmacoeconomic implications of new therapies in sepsis. PharmacoEconomics. 2004;22(14):895-906. 3. Mayr FB, Talisa VB, Balakumar V, Chang CH, Fine M, Yende S. Proportion and cost of unplanned 30-day readmissions after sepsis compared with other medical conditions. JAMA. doi:10.1001/jama.2016.20468. [Published online January 20, 2017]. 4. Statistical Brief #204. Healthcare Cost and Utilization Project (HCUP). April 2016.
  4. 4. © 2017 Indegene. All rights reserved. Subscribe to our blog to learn more on clinical variation reduction best-practices.