国家规定的败血症护理与成人败血症住院死亡率之间的关联
Jeremy M Kahn1,2, Billie S Davis1, Jonathan G Yabes3,4
1CRISMA Center, Department of Critical Care Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania.
JAMA
|July 17, 2019
概括
纽约州的败血症法规要求基于证据的协议显著降低了与败血症相关的死亡率. 这项研究发现,与对照州相比,纽约的败血症死亡率下降得更大,证明了强制性败血症护理的有效性.
科学领域:
- 医疗保健政策
- 传染病管理
- 公共卫生监测
背景情况:
- 2013年,纽约州对医院制定了基于证据的败血症管理协议和数据报告.
- 这些败血症法规对患者结局的影响尚未研究.
研究的目的:
- 评估纽约州的败血症法规与住院败血症病例的患者结果之间的关联.
- 将纽约的败血症结果与没有类似授权的控制状态进行比较.
主要方法:
- 一项回顾性队列研究分析了2011年1月至2015年9月的所有付款人退院数据.
- 包括纽约和四个对照州 (FL,MD,MA,NJ) 住院的成年患者.
- 使用比较的中断时间序列分析来评估监管前后的结果.
主要成果:
- 与对照国家相比,纽约州的败血症法规与30天住院死亡率的显著下降有关 (P=.02).
- 观察到Clostridium difficile感染率 (P<. 001) 和住院时间 (P=. 04) 的相对显著下降.
- 在ICU入院率上没有显著的差异 (P=0. 09),但在中央静脉导管使用率上有显著的增加 (P=0. 02).
结论:
- 在纽约,强制性治疗的败血症与败血症死亡率的降低比对照状态更大.
- 这些发现表明全州性败血症法规在改善患者的治疗结果方面具有有效性.
- 由于纽约和比较州的基线死亡率不同,一般化可能是有限的.
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