GH Workforce Taskshifting: Shevin Jacob

Surviving Sepsis in Uganda: a Role for Patient Attendants in Task Shifting Shevin T Jacob, MD, MPH University of Washington [email_address] 18th Annual GHEC/ 7 th Annual WRIH Conference 4 April 2009

Sepsis pathophysiology RS Hotchkiss, et al . NEJM 2003; 348:138-150.

RP Wenzel. NEJM 2002; 347 (13): 966-967

Mortality and DALYs Lost in 2002, Adults 15-60 Yrs Old AC Cheng, et al. PLoS Medicine ; 2008; 5(8): 1173-1179.

Sepsis management ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],E Rivers, et al. NEJM 2001; 345(19): 1368-1377. Cheng, et al. PLoS Medicine 2008; 5(8):1173-1179.

PRISM-U : P romoting R esource-Limited I nterventions for S epsis M anagement in U ganda ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

PRISM-U, Part 1 ,[object Object]

Study details ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Methods: Data collection ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Results: Patient characteristics ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Results: Outcomes ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Results: Intravenous Fluid Resuscitation ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],SurvivingSepsisCampaign. http://www.survivingsepsis.org/bundles/individual_changes/treat_hypotension .

Intravenous Fluid Resuscitation, cont IV fluid volume received within first 6 hours ,[object Object],[object Object]

PRISM-U1: Summary points ,[object Object],[object Object],[object Object],[object Object]

The next step… ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

PRISM-U, Part 2: Improving Management, Investigating Pathogenesis ,[object Object],[object Object],[object Object],[object Object]

PRISM-U2 Methodology: Enrollment criteria ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

PRISM-U2 Methodology: Role of attendants ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Interim analysis (n=134 patients) Historic Control Group: Mortality 40% (s.e.=0.4) Fluid Intervention Group: Mortality 27% (s.e.=0.7)

The way forward... opportunities and challenges ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Acknowledgments ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

GH Workforce Taskshifting: Shevin Jacob

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GH Workforce Taskshifting: Shevin Jacob