Jeremy M. Kahn
State-mandated sepsis care in New York was associated with a greater decrease in mortality in adults hospitalized with sepsis compared with states that do not have similar protocols, according to findings from a retrospective cohort study published in JAMA.
“Sepsis is a public health crisis affecting millions of patients each year,” Jeremy M. Kahn, MD, MS, professor of critical care medicine and health policy management and vice chair for academic affairs in the department of critical care medicine at the University of Pittsburgh, told Infectious Disease News. “Early recognition and treatment save lives, but unfortunately, many patients don’t receive high-quality care. Although mandating the use of evidence-based practices is controversial, we show that at least in this case, it appears to have worked.”
In 2013, New York state mandated that all acute-care hospitals adopt evidence-based protocols for sepsis recognition and treatment. Previous research found that rapid care and delivery of antibiotics in accordance with the mandate — called Rory’s Regulations — resulted in decreased mortality risk.
For their study, Kahn and colleagues included 1,012,410 sepsis admissions between January 2011 and March 2013 using all-payer hospital discharge data from 509 hospitals in New York and four control states — Florida, Maryland, Massachusetts and New Jersey. The primary outcome was 30-day in-hospital mortality, they wrote.
Before the passing of the regulations in 2013, the unadjusted 30-day in-hospital mortality among patients diagnosed with sepsis in New York was 26.3%, compared with 22% in the control states, Kahn and colleagues reported. Following the regulations, New York’s sepsis mortality rate dropped 4.3% to 22%. In the control states, the rate decreased 2.9% to 19.1%.
According to the researchers, New York state’s adjusted absolute mortality was 3.2% (95% CI, 1% to 5.4%) lower than expected by the 10th quarter after implementation of the regulations compared with the control states (P = .004).
The regulations also were associated with significant relative decreases in hospital length of stay (P = .04) and Clostridioides difficile infection rate (P < .001), as well as a significant relative increase in central venous catheter use (P = .02). They were associated with no significant differences in ICU admission (P = .09), according to the study.
Kahn said the data strongly suggest that the regulations effectively reduced sepsis death rates.
“Right now, about 12 states are actively considering these regulations, and many others are considering them,” Kahn said. “Our data clearly show that these regulations work in New York and they are likely to work elsewhere. However, given that New York is unique in many ways, states should consider looking at their own sepsis outcomes before fully adopting sepsis mandates.”
If a state’s sepsis outcomes are already favorable because of regional quality improvement efforts or other initiatives, “they may not see as strong an effect as we saw in New York,” Kahn said. – by Joe Gramigna
Disclosures: Kahn reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.