Sepsis
Conditions
Keywords
Telemedicine
Brief summary
Sepsis is a life-threatening emergency for which provider-to-provider telemedicine has been used to improve quality of care. The objective of this study is to measure the impact of rural tele-emergency consultation on long-term health care costs and outcomes through decreasing organ failure, hospital length-of-stay, and readmissions.
Detailed description
Sepsis is responsible for over 1.7 million hospitalizations at a cost of $26 billion annually, making it the most expensive acute care condition in US hospitals. High-quality early sepsis care has been associated with decreased organ failure, shorter ICU and hospital length-of-stay, and improved survival. Rural sepsis patients are more likely to be transferred to tertiary centers, and they also have higher mortality and health care costs. ED-based telemedicine (tele-ED) consultation between a rural provider and a board-certified emergency physician may deliver the expertise to reduce care delays and improve outcomes while avoiding unnecessary costs. In 2017, the study team partnered with Avera eCARE, the largest tele-ED provider in North America, to implement a standard telemedicine-based sepsis care pathway. Subsequently, the investigators showed (using patient-level primary data collection across several networks) that tele-ED use was associated with improved adherence with international sepsis guidelines. In addition to its association with short-term clinical outcomes, however, the study team hypothesize that telemedicine may also decrease costs. The investigators have shown that high-quality sepsis care is associated with decreased readmissions and post-discharge mortality. High quality care may also prevent organ failure, avoid ICU admissions, reduce mechanical ventilation and vasopressor use, decrease ICU and hospital length-of-stay, and decrease post-discharge care-primarily through reducing avoidable organ failure. All of these factors are likely to have a significant effect in terms of reducing healthcare cost. The objective of the proposed project is to measure the effect of tele-ED consultation at reducing healthcare costs and long-term outcomes in sepsis patients in rural EDs. The following primary hypotheses will be tested: * Total healthcare expenses and 90-day mortality will be lower in patients treated in a tele-ED hospital, with the effect primarily through reduced hospital length-of-stay and fewer readmissions. * Total expenses and mortality will be lower in cases where tele-ED is used vs. matched controls in non-tele-ED hospitals.
Interventions
OTHERTelemedicine
Receiving care in a tele-ED hospital
Sponsors
Health Resources and Services Administration (HRSA)
Nicholas M Mohr
Study design
Observational model
COHORT
Time perspective
RETROSPECTIVE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Sepsis, according to ICD-10 codes
Exclusion criteria
* No infection diagnosed in the ED
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Total healthcare expenditures | From hospital admission until 30 days after discharge | Defined as direct inpatient and outpatient payments to hospitals and physicians, skilled nursing care, home care, durable medical equipment, and ambulance costs from the ED visit until 30 days post-discharge. Drugs are not included. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Number of participants who die within 90 days of hospital admission | From hospital admission until 90 days after admission | 90-day mortality |
| Number of participants requiring ICU care | From the date of hospital admission through hospital discharge or 90 days, whichever comes first, the number of participants who are treated in an intensive care unit | Any admission to the ICU |
| Emergency department costs | From the date of hospital admission through hospital discharge or 90 days, whichever comes first, all emergency department health care expenditures | Total healthcare expenditures related to emergency department care in current hospitalization |
| Hospital length-of-stay | From date of hospitalization through hospital discharge, assessed up to 90 days | Duration of hospitalization |
| Inter-hospital transfer costs | From the date of hospital admission through hospital discharge or 90 days, whichever comes first, all inter-hospital transfer health care expenditures | Emergency medical services transfer costs and second emergency department costs (if transferred) |
| Post-discharge costs | From the date of hospital discharge through 30 days after discharge, total health care expenditures health care expenditures | Total healthcare expenditures |
| Readmission costs | Between hospital discharge and 30 days after hospital discharge, related to inpatient re-hospitalization | Total healthcare expenditures during readmission(s) within 30 days after initial hospital discharge |
| Inpatient care costs | From the date of hospital admission through hospital discharge or 90 days, whichever comes first, all inpatient health care expenditures | Total healthcare expenditures related to inpatient care in current hospitalizations |
Countries
United States
Outcome results
None listed