Stop Sepsis Now
Community Based Sepsis
Sepsis is defined as whole-body inflammatory response to infection - for Medicare nationwide, septicemia is the principal discharge diagnosis, exceeding 700,000 hospital discharges a year, and is the costliest diagnosis condition, consuming 6.9% of Medicare payments annually.
Sepsis ranks number one for all-payer hospital discharges, exceeding one million discharges a year and representing 5.2% of all healthcare costs (AHRQ, 2011). For Medicare, septicemia (except in labor) is the principal discharge diagnosis exceeding 700,000 hospital discharges a year, and the costliest diagnosis condition, consuming 6.9% of all Medicare payments yearly (AHRQ). In both New York and South Carolina, sepsis is one of five top all-payer admission drivers; for Medicare beneficiaries, it is the number one driver of 30-day readmissions (21.3%). It also carries an inpatient hospitalization mortality rate of 14% in South Carolina and 17% in New York, which is three to four times greater than the all-diagnosis Medicare in-hospital mortality rate of 4.2%.
In an effort to increase rapid treatment responses to sepsis and to reduce sepsis mortalities in communities, Atlantic Quality Innovation Network (AQIN) members IPRO and the Carolinas Center for Medical Excellence (CCME) are undertaking a Community-Based Sepsis Initiative in NY and South Carolina to:
- Facilitate education and build awareness of sepsis among pre-hospital providers and caregivers in contact with at-risk community dwelling Medicare beneficiaries. Those most at-risk include the elderly and those with weakened or compromised immune systems, chronic diseases, diabetes, cancer, AIDS, kidney or liver disease and recent physical traumas (NIH, 2015). Two thirds of individuals hospitalized for sepsis are over 65 years old (CDC, 2011).
- Identify best practice protocols and educate pre-hospital providers on the recognition and importance of efficient referral to the next level of care for emergent care management using resources such as Guidelines for Management of Severe Sepsis and Septic Shock.
- Improve processes of care transitions and care pathways with sepsis treatment between pre-hospital and hospital/emergency care setting providers.
- Increase public awareness of the signs, symptoms, and contributing factors to sepsis through community outreach, public service announcements, and social media.
AQIN's Community Based Sepsis Initiative will utilize existing evidence based protocols and resources found in the Guidelines for Management of Severe Sepsis and Septic Shock: 2012 (http://www.survivingsepsis.org/guidelines/Pages/default.aspx), created by 68 international experts and supported by the Surviving Sepsis Campaign (http://www.survivingsepsis.org/About-SSC/Pages/default.aspx). Screening, diagnosis, and management and treatment protocols are addressed as well as recommendations for specific populations (RP Dellinger et al, 2013). Resources, tools, and clinical training programs adapted from the Surviving Sepsis Campaign will be utilized for the expansive network of hospital and pre-hospital providers serving Medicare beneficiaries at risk for sepsis related mortality and morbidity within AQIN.
AQIN will leverage existing partnerships with national and state-based organizations whose interests are aligned with the project's, i.e., focused on addressing early identification and treatment of sepsis. Partner organizations such as the Sepsis Alliance, Home Care Association of New York State, the Rory Staunton Foundation and the Medical University of South Carolina (MUSC) have made significant headway in their sepsis efforts.
AQIN shares CMS' commitment to achieve the National Quality Strategy (NQS) and the CMS Quality Strategy (CQS) that support the three-part aim of improving health, improving care, and lowering costs using innovative techniques. AQIN's proposed Community Based Sepsis Initiative aligns with the NQS and CQS goals as follows:
- Making care safer by reducing harm. By educating and engaging pre-hospital providers and caregivers in contact with at-risk Medicare patients in the community on the signs and symptoms of sepsis, earlier recognition of sepsis will expedite the rapid response that is required to reduce harm and improve outcomes. (Mayo Clinic, 2015)
- Strengthen person and family engagement. As the Community Based Sepsis Initiative performs pre-hospital outreach and education, it will provide opportunities for Medicare beneficiaries, caregivers, and sepsis survivors to participate in learning and sharing workshops. Participation will include, but not be limited to, education, focus groups, caregiving, and peer support.
- Promote effective communication and coordination of care. AQIN will apply expertise in community organizing techniques, ensuring effective communication, collaboration, and cooperation, and partnerships that reach across cross-setting pre-hospital care platforms and touch all Medicare community providers: SNFs, HHCs, physician practices, community care givers, and community service providers.
- Promote effective prevention and treatment for chronic care. Less than 10% of emergency responders have accurate sepsis knowledge (Baez AA et al, 2013). The Community Based Sepsis Initiative aims to better inform pre-hospital caregivers on the signs and symptoms of sepsis. Our targeted educational outreach efforts will help to inform community providers on the early onset of sepsis and expedite an earlier treatment response that will prevent severe sepsis or septic shock.
- Work with communities to promote best practices of healthy living. As the Community Based Sepsis Initiative performs outreach and education, it will involve each specific audience (e.g., SNFs, HHCs, caregivers, etc.) and promote best practices, resources, and tools aligned with accepted sepsis guidelines.
- Make care affordable. Sepsis-related care and readmissions are very costly to Medicare, exceeding over 20 billion dollars a year nationally. Increased community awareness and education on sepsis and its signs and symptoms will contribute to earlier recognition and treatments, thereby reducing complications, morbidities, and mortalities among Medicare patients. This, in turn, will reduce the need for costlier and longer hospitalizations, and readmissions.
For More Information on Sepsis:
- Surviving Sepsis Campaign: http://www.survivingsepsis.org/Pages/default.aspx
- Centers for Disease Control (CDC): http://www.cdc.gov/sepsis/clinicaltools/index.html
- Sepsis Alliance: http://www.sepsis.org/
- Rory Staunton Foundation: https://rorystauntonfoundationforsepsis.org/