A Pragmatic Stepped-Wedge Hybrid Effectiveness-Implementation Trial Evaluating Engagement and Collaborative Management to Proactively Advance Sepsis Survivorship (ENCOMPASS)

Join us as this presenter discusses this poster live on May 26, 2021 | Track B at 12:15 PM Mountain

PRESENTER
MARC KOWALKOWSKI, PhD
Atrium Health
BACKGROUND
Sepsis survivors experience high morbidity and mortality, and healthcare systems lack effective strategies to address patient needs after hospital discharge. The Sepsis Transition and Recovery (STAR) program is a navigator-led, telehealth-based multicomponent strategy to provide proactive care coordination and monitoring of high-risk patients using evidence-driven, post-sepsis care tasks. The purpose of this study is to evaluate the effectiveness of STAR to improve outcomes for sepsis patients and to examine contextual factors that influence STAR implementation.
METHODS
This study uses a hybrid type I effectiveness-implementation design to concurrently test clinical effectiveness and gather implementation data. The effectiveness evaluation is a two-arm, pragmatic, stepped-wedge cluster randomized controlled trial at eight hospitals in North Carolina comparing clinical outcomes between sepsis survivors who receive Usual Care versus care delivered through STAR. Each hospital begins in a Usual Care control phase and transitions to STAR in a randomly assigned sequence (one every four months). During months that a hospital is allocated to Usual Care, all eligible patients will receive usual care. Once a hospital transitions to STAR, all eligible patients will receive STAR during their hospitalization and extending through 90 days from discharge. STAR includes centrally located nurse navigators using telephonic counseling and electronic health record-based support to facilitate best-practice post-sepsis care strategies including post-discharge review of medications, evaluation for new impairments or symptoms, monitoring existing comorbidities, and palliative care referral when appropriate. Adults admitted with suspected sepsis, defined by clinical criteria for infection and organ failure, are included. Planned enrollment is 4032 patients during a 36-month period; as of March 26, 999 (25%) patients have been enrolled, which is on target. The primary effectiveness outcome is the composite of all-cause hospital readmission or mortality within 90 days of discharge. We are conducting an implementation determinants evaluation conceptually guided by the Consolidated Framework for Implementation Research (CFIR) before, during, and after STAR implementation. To increase policy impact, we are also conducting a prospective economic evaluation to provide an understanding of the resource implications of the STAR program intervention on post-sepsis health benefits and costs.
DISCUSSION
This pragmatic evaluation will test the effectiveness of STAR to reduce combined hospital readmissions and mortality, while identifying key implementation factors. Results will provide practical information to advance understanding of how to integrate post-sepsis management across care settings and facilitate implementation, dissemination, and sustained utilization of best-practice post-sepsis management strategies in other heterogeneous healthcare delivery systems.
POSTER

Loader Loading...
EAD Logo Taking too long?

Reload Reload document
| Open Open in new tab

Posted in 2021 Poster Session, Pragmatic Trials.