Proactive Telehealth-Based Sepsis Transition and Recovery Support, Hospital Readmission, and Mortality
Stephanie Parks Taylor, Tara Eaton, Aleta Rios, Desiree Boyd, Hazel Tapp, Andrew McWilliams, Shih‐Hsiung Chou, Scott D. Halpern, Derek C. Angus, Lewis McCurdy, Asha Ganesan, Hieu Nguyen, C. Danielle Connor, Marc Kowalkowski
Abstract
Importance: Sepsis survivors experience high morbidity and mortality after discharge, but health systems lack effective approaches to improve recovery. Objective: To evaluate the effect of a sepsis transition and recovery (STAR) program compared with usual care on postdischarge outcomes. Design, Setting, and Participants: The ENCOMPASS (Engagement and Collaborative Management to Proactively Advance Sepsis Survivorship) stepped-wedge cluster randomized clinical trial was conducted among adults hospitalized with sepsis at 7 US hospitals in a single health care system from July 2020 to June 2023. Each hospital was a cluster, with 1 randomly transitioning to STAR every 4 months. Follow-up ended in December 2023. Interventions: The STAR program was a navigator-led, telehealth-based strategy to proactively deliver evidence-driven postsepsis care to high-risk patients for 90 days after discharge. Main Outcomes and Measures: The primary outcome was the composite of all-cause hospital readmission or mortality within 90 days of discharge. Results: Of 3548 patients enrolled, 1843 (52%) were women, and the median (IQR) age was 68 (57-77) years; 1160 (33%) were admitted to the intensive care unit. A total of 1426 patients were randomized to the usual care group and 2122 patients were randomized to the STAR group. In the STAR group, 1393 patients (66%) engaged with the STAR program at least once after discharge. The composite all-cause readmission or mortality at 90 days did not differ between the STAR and usual care groups (1023 [48.2%] vs 684 [48.0%]; adjusted odds ratio, 1.05; 95% CI, 0.90-1.24; P = .53). Analysis of the outcomes separately demonstrated a lower frequency of death among patients in the STAR group compared with those in the usual care group (367 [17.3%] vs 292 [20.5%]; adjusted odds ratio, 0.88; 95% CI, 0.77-0.99; P = .04) and a higher frequency of readmission among patients in the STAR group (763 [35.9%] vs 478 [33.5%]; adjusted odds ratio, 1.13; 95% CI, 0.92-1.38; P = .24). Conclusions and Relevance: In this randomized clinical trial, a multicomponent, navigator-led STAR program did not reduce the composite of all-cause readmission and mortality at 90 days after discharge. Trial Registration: ClinicalTrials.gov Identifier: NCT04495946.