Passing the SNF Test: A Secondary Analysis of a Sepsis Transition Intervention Trial Among Patients Discharged to Post-Acute Care

Nicholas A Colucciello; Marc A Kowalkowski; Maria Kooken; Gabriel Wardi; Stephanie P Taylor

doi:10.1016/j.jamda.2023.02.009

Passing the SNF Test: A Secondary Analysis of a Sepsis Transition Intervention Trial Among Patients Discharged to Post-Acute Care

J Am Med Dir Assoc. 2023 May;24(5):742-746.e1. doi: 10.1016/j.jamda.2023.02.009. Epub 2023 Mar 11.

Authors

Nicholas A Colucciello¹, Marc A Kowalkowski², Maria Kooken³, Gabriel Wardi⁴, Stephanie P Taylor⁵

Affiliations

¹ Department of Internal Medicine, Atrium Health, Charlotte, NC, USA. Electronic address: ncolucciello95@gmail.com.
² Center for Outcomes Research and Evaluation, Atrium Health, Charlotte, NC, USA.
³ Department of Pediatrics, Atrium Health, Charlotte, NC, USA.
⁴ Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, University of California, San Diego, La Jolla, CA, USA.
⁵ Department of Internal Medicine, Atrium Health, Charlotte, NC, USA; Department of Internal Medicine, Wake Forest School of Medicine, Charlotte, NC, USA.

PMID: 36918147
DOI: 10.1016/j.jamda.2023.02.009

Abstract

Objectives: Sepsis survivors discharged to post-acute care facilities experience high rates of mortality and hospital readmission. This study compared the effects of a Sepsis Transition and Recovery (STAR) program vs usual care (UC) on 30-day mortality and hospital readmission among sepsis survivors discharged to post-acute care.

Design: Secondary analysis of a multisite pragmatic randomized clinical trial.

Setting and participants: Sepsis survivors discharged to post-acute care.

Methods: We conducted a secondary analysis of patients from the IMPACTS (Improving Morbidity During Post-Acute Care Transitions for Sepsis) randomized clinical trial who were discharged to post-acute care. IMPACTS evaluated the effectiveness of STAR, a nurse-navigator-led program to deliver best practice post-sepsis care. Subjects were randomized to receive either STAR or UC. The primary outcome was 30-day readmission and mortality. We also evaluated hospital-free days alive as a secondary outcome.

Results: Of 691 patients enrolled in IMPACTS, 175 (25%) were discharged to post-acute care [143 (82%) to skilled nursing facilities, 12 (7%) to long-term acute care hospitals, and 20 (11%) to inpatient rehabilitation]. Of these, 87 received UC and 88 received the STAR intervention. The composite 30-day all-cause mortality and readmission endpoint occurred in 26 (29.9%) patients in the UC group vs 18 (20.5%) in the STAR group [risk difference -9.4% (95% CI -22.2 to 3.4); adjusted odds ratio 0.58 (95% CI 0.28 to 1.17)]. Separately, 30-day all-cause mortality was 8.1% in the UC group compared with 5.7% in the STAR group [risk difference -2.4% (95% CI -9.9 to 5.1)] and 30-day all-cause readmission was 26.4% in the UC group compared with 17.1% in the STAR program [risk difference -9.4% (95% CI -21.5 to 2.8)].

Conclusions and implications: There are few proven interventions to reduce readmission among patients discharged to post-acute care facilities. These results suggest the STAR program may reduce 30-day mortality and readmission rates among sepsis survivors discharged to post-acute care facilities.

Keywords: Sepsis; mortality; post-acute care; readmission; rehabilitation.

Publication types

Randomized Controlled Trial
Pragmatic Clinical Trial

MeSH terms

Humans
Patient Discharge*
Patient Readmission
Retrospective Studies
Sepsis* / therapy
Skilled Nursing Facilities
Subacute Care