The German Quality Network Sepsis: Evaluation of a Quality Collaborative on Decreasing Sepsis-Related Mortality in a Controlled Interrupted Time Series Analysis
BackgroundSepsis is one of the leading causes of preventable deaths in hospitals. This study presents the evaluation of a quality collaborative, which aimed to decrease sepsis-related hospital mortality.MethodsThe German Quality Network Sepsis (GQNS) offers quality reporting based on claims data, pe...
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Frontiers Media S.A.
2022-04-01
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| Series: | Frontiers in Medicine |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fmed.2022.882340/full |
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| author | Daniel Schwarzkopf Daniel Schwarzkopf Daniel Schwarzkopf Hendrik Rüddel Hendrik Rüddel Alexander Brinkmann Carolin Fleischmann-Struzek Carolin Fleischmann-Struzek Marcus E. Friedrich Michael Glas Christian Gogoll Matthias Gründling Patrick Meybohm Mathias W. Pletz Torsten Schreiber Daniel O. Thomas-Rüddel Konrad Reinhart Konrad Reinhart Konrad Reinhart |
| author_facet | Daniel Schwarzkopf Daniel Schwarzkopf Daniel Schwarzkopf Hendrik Rüddel Hendrik Rüddel Alexander Brinkmann Carolin Fleischmann-Struzek Carolin Fleischmann-Struzek Marcus E. Friedrich Michael Glas Christian Gogoll Matthias Gründling Patrick Meybohm Mathias W. Pletz Torsten Schreiber Daniel O. Thomas-Rüddel Konrad Reinhart Konrad Reinhart Konrad Reinhart |
| author_sort | Daniel Schwarzkopf |
| collection | DOAJ |
| description | BackgroundSepsis is one of the leading causes of preventable deaths in hospitals. This study presents the evaluation of a quality collaborative, which aimed to decrease sepsis-related hospital mortality.MethodsThe German Quality Network Sepsis (GQNS) offers quality reporting based on claims data, peer reviews, and support for establishing continuous quality management and staff education. This study evaluates the effects of participating in the GQNS during the intervention period (April 2016–June 2018) in comparison to a retrospective baseline (January 2014–March 2016). The primary outcome was all-cause risk-adjusted hospital mortality among cases with sepsis. Sepsis was identified by International Classification of Diseases (ICD) codes in claims data. A controlled time series analysis was conducted to analyze changes from the baseline to the intervention period comparing GQNS hospitals with the population of all German hospitals assessed via the national diagnosis-related groups (DRGs)-statistics. Tests were conducted using piecewise hierarchical models. Implementation processes and barriers were assessed by surveys of local leaders of quality improvement teams.ResultsSeventy-four hospitals participated, of which 17 were university hospitals and 18 were tertiary care facilities. Observed mortality was 43.5% during baseline period and 42.7% during intervention period. Interrupted time-series analyses did not show effects on course or level of risk-adjusted mortality of cases with sepsis compared to the national DRG-statistics after the beginning of the intervention period (p = 0.632 and p = 0.512, respectively). There was no significant mortality decrease in the subgroups of patients with septic shock or ventilation >24 h or predefined subgroups of hospitals. A standardized survey among 49 local quality improvement leaders in autumn of 2018 revealed that most hospitals did not succeed in implementing a continuous quality management program or relevant measures to improve early recognition and treatment of sepsis. Barriers perceived most commonly were lack of time (77.6%), staff shortage (59.2%), and lack of participation of relevant departments (38.8%).ConclusionAs long as hospital-wide sepsis quality improvement efforts will not become a high priority for the hospital leadership by assuring adequate resources and involvement of all pertinent stakeholders, voluntary initiatives to improve the quality of sepsis care will remain prone to failure. |
| first_indexed | 2024-04-14T05:49:35Z |
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| issn | 2296-858X |
| language | English |
| last_indexed | 2024-04-14T05:49:35Z |
| publishDate | 2022-04-01 |
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| series | Frontiers in Medicine |
| spelling | doaj.art-a7d8a972ca114d75b7a1292274fed9ed2022-12-22T02:09:10ZengFrontiers Media S.A.Frontiers in Medicine2296-858X2022-04-01910.3389/fmed.2022.882340882340The German Quality Network Sepsis: Evaluation of a Quality Collaborative on Decreasing Sepsis-Related Mortality in a Controlled Interrupted Time Series AnalysisDaniel Schwarzkopf0Daniel Schwarzkopf1Daniel Schwarzkopf2Hendrik Rüddel3Hendrik Rüddel4Alexander Brinkmann5Carolin Fleischmann-Struzek6Carolin Fleischmann-Struzek7Marcus E. Friedrich8Michael Glas9Christian Gogoll10Matthias Gründling11Patrick Meybohm12Mathias W. Pletz13Torsten Schreiber14Daniel O. Thomas-Rüddel15Konrad Reinhart16Konrad Reinhart17Konrad Reinhart18Integrated Research and Treatment Center for Sepsis Control and Care (CSCC), Jena University Hospital, Jena, GermanyDepartment for Anesthesiology and Intensive Care Medicine, Jena University Hospital, Jena, GermanyInstitute for Infectious Diseases and Infection Control, Jena University Hospital, Jena, GermanyIntegrated Research and Treatment Center for Sepsis Control and Care (CSCC), Jena University Hospital, Jena, GermanyDepartment for Anesthesiology and Intensive Care Medicine, Jena University Hospital, Jena, GermanyDepartment of Anesthesiology and Intensive Care Medicine, General Hospital of Heidenheim, Heidenheim, GermanyIntegrated Research and Treatment Center for Sepsis Control and Care (CSCC), Jena University Hospital, Jena, GermanyInstitute for Infectious Diseases and Infection Control, Jena University Hospital, Jena, GermanyNew York State Department of Health, Albany, NY, United StatesDepartment for Infectious Diseases and Infection Control, KH Labor GmbH, AMEOS Group, Bernburg, GermanyOutpatient Services, Evangelische Lungenklinik Berlin-Buch, Berlin, GermanyDepartment of Anesthesiology, University Hospital of Greifswald, Greifswald, GermanyDepartment of Anesthesiology, Intensive Care, Emergency and Pain Medicine, University Hospital Wuerzburg, Wuerzburg, GermanyInstitute for Infectious Diseases and Infection Control, Jena University Hospital, Jena, Germany0Department of Anesthesia and Intensive Care, Zentralklinik Bad Berka, Bad Berka, Germany1Berlin Institute of Health, Campus Virchow-Klinikum, Berlin, GermanyIntegrated Research and Treatment Center for Sepsis Control and Care (CSCC), Jena University Hospital, Jena, Germany1Berlin Institute of Health, Campus Virchow-Klinikum, Berlin, Germany2Department of Anesthesiology and Operative Intensive Care Medicine (CCM, CVK), Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, GermanyBackgroundSepsis is one of the leading causes of preventable deaths in hospitals. This study presents the evaluation of a quality collaborative, which aimed to decrease sepsis-related hospital mortality.MethodsThe German Quality Network Sepsis (GQNS) offers quality reporting based on claims data, peer reviews, and support for establishing continuous quality management and staff education. This study evaluates the effects of participating in the GQNS during the intervention period (April 2016–June 2018) in comparison to a retrospective baseline (January 2014–March 2016). The primary outcome was all-cause risk-adjusted hospital mortality among cases with sepsis. Sepsis was identified by International Classification of Diseases (ICD) codes in claims data. A controlled time series analysis was conducted to analyze changes from the baseline to the intervention period comparing GQNS hospitals with the population of all German hospitals assessed via the national diagnosis-related groups (DRGs)-statistics. Tests were conducted using piecewise hierarchical models. Implementation processes and barriers were assessed by surveys of local leaders of quality improvement teams.ResultsSeventy-four hospitals participated, of which 17 were university hospitals and 18 were tertiary care facilities. Observed mortality was 43.5% during baseline period and 42.7% during intervention period. Interrupted time-series analyses did not show effects on course or level of risk-adjusted mortality of cases with sepsis compared to the national DRG-statistics after the beginning of the intervention period (p = 0.632 and p = 0.512, respectively). There was no significant mortality decrease in the subgroups of patients with septic shock or ventilation >24 h or predefined subgroups of hospitals. A standardized survey among 49 local quality improvement leaders in autumn of 2018 revealed that most hospitals did not succeed in implementing a continuous quality management program or relevant measures to improve early recognition and treatment of sepsis. Barriers perceived most commonly were lack of time (77.6%), staff shortage (59.2%), and lack of participation of relevant departments (38.8%).ConclusionAs long as hospital-wide sepsis quality improvement efforts will not become a high priority for the hospital leadership by assuring adequate resources and involvement of all pertinent stakeholders, voluntary initiatives to improve the quality of sepsis care will remain prone to failure.https://www.frontiersin.org/articles/10.3389/fmed.2022.882340/fullsepsismortalityquality improvementrisk adjustmentadministrative claimsinterdisciplinary health team |
| spellingShingle | Daniel Schwarzkopf Daniel Schwarzkopf Daniel Schwarzkopf Hendrik Rüddel Hendrik Rüddel Alexander Brinkmann Carolin Fleischmann-Struzek Carolin Fleischmann-Struzek Marcus E. Friedrich Michael Glas Christian Gogoll Matthias Gründling Patrick Meybohm Mathias W. Pletz Torsten Schreiber Daniel O. Thomas-Rüddel Konrad Reinhart Konrad Reinhart Konrad Reinhart The German Quality Network Sepsis: Evaluation of a Quality Collaborative on Decreasing Sepsis-Related Mortality in a Controlled Interrupted Time Series Analysis Frontiers in Medicine sepsis mortality quality improvement risk adjustment administrative claims interdisciplinary health team |
| title | The German Quality Network Sepsis: Evaluation of a Quality Collaborative on Decreasing Sepsis-Related Mortality in a Controlled Interrupted Time Series Analysis |
| title_full | The German Quality Network Sepsis: Evaluation of a Quality Collaborative on Decreasing Sepsis-Related Mortality in a Controlled Interrupted Time Series Analysis |
| title_fullStr | The German Quality Network Sepsis: Evaluation of a Quality Collaborative on Decreasing Sepsis-Related Mortality in a Controlled Interrupted Time Series Analysis |
| title_full_unstemmed | The German Quality Network Sepsis: Evaluation of a Quality Collaborative on Decreasing Sepsis-Related Mortality in a Controlled Interrupted Time Series Analysis |
| title_short | The German Quality Network Sepsis: Evaluation of a Quality Collaborative on Decreasing Sepsis-Related Mortality in a Controlled Interrupted Time Series Analysis |
| title_sort | german quality network sepsis evaluation of a quality collaborative on decreasing sepsis related mortality in a controlled interrupted time series analysis |
| topic | sepsis mortality quality improvement risk adjustment administrative claims interdisciplinary health team |
| url | https://www.frontiersin.org/articles/10.3389/fmed.2022.882340/full |
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