Social Determinants of Health and Risk-Adjusted Sepsis Mortality in the Nationwide Veterans Affairs Healthcare System.

Importance: Traditional risk prediction and risk adjustment models have focused on clinical characteristics, but accounting for social determinants of health (SDOH) and complex health conditions could improve understanding of sepsis outcomes and our ability to predict outcomes, treat patients, and assess quality of care.

Objective: To evaluate the impact of SDOH and health scales in sepsis mortality risk prediction and hospital performance assessment.

Design: Observational cohort study.

Development and validation of a pulmonary function test data extraction tool for the US department of veterans affairs electronic health record.

Objective: Pulmonary function test (PFT) results are recorded variably across hospitals in the Department of Veterans Affairs (VA) electronic health record (EHR), using both unstructured and semi-structured notes. We developed and validated a hospital-specific code to extract pre-bronchodilator measures of obstruction (ratio of forced expiratory volume in one second [FEV] to forced vital capacity [FVC]) and severity of obstruction (percent predicted of FEV).

Results: Among 36 VA facilities with the most PFTs completed between 2018 and 2022 from a parent cohort of veterans receiving long-acting controller inhalers, 12 had a consistent syntactical convention or template for reporting PFT data in the EHR.

A Multi-Hospital Survey of Current Practices for Supporting Recovery From Sepsis.

Unlabelled: Sepsis survivors are at increased risk for morbidity and functional impairment. There are recommended practices to support recovery after sepsis, but it is unclear how often they are implemented. We sought to assess the current use of recovery-based practices across hospitals.

Comparison of Administrative versus Electronic Health Record-based Methods for Identifying Sepsis Hospitalizations.

Despite the importance of sepsis surveillance, no optimal approach for identifying sepsis hospitalizations exists. The Centers for Disease Control and Prevention Adult Sepsis Event Definition (CDC-ASE) is an electronic medical record-based algorithm that yields more stable estimates over time than diagnostic coding-based approaches but may still result in misclassification. We sought to assess three approaches to identifying sepsis hospitalizations, including a modified CDC-ASE.

Receipt of Recovery-Oriented Care Practices During Hospitalization for Sepsis.

Unlabelled: Survivors of sepsis hospitalization are at high risk for postsepsis morbidity, readmission, and death, but these negative outcomes can be mitigated by receipt of recommended care practices. We sought to assess factors associated with the receipt of recommended recovery-oriented care practices during hospitalization for sepsis. We hypothesized that patients treated in the ICU may be more likely than ward-treated patients to receive recommended care practices given the increasing focus on survivorship in the critical care field.

Temporal Trends in Antimicrobial Prescribing During Hospitalization for Potential Infection and Sepsis.

Importance: Some experts have cautioned that national and health system emphasis on rapid administration of antimicrobials for sepsis may increase overall antimicrobial use even among patients without sepsis.

Objective: To assess whether temporal changes in antimicrobial timing for sepsis are associated with increasing antimicrobial use, days of therapy, or broadness of antimicrobial coverage among all hospitalized patients at risk for sepsis.

Design, Setting, And Participants: This is an observational cohort study of hospitalized patients at 152 hospitals in 2 health care systems during 2013 to 2018, admitted via the emergency department with 2 or more systemic inflammatory response syndrome (SIRS) criteria.

Interpretability, credibility, and usability of hospital-specific template matching versus regression-based hospital performance assessments; a multiple methods study.

Background: Hospital-specific template matching (HS-TM) is a newer method of hospital performance assessment.

Objective: To assess the interpretability, credibility, and usability of HS-TM-based vs. regression-based performance assessments.

Temporal Trends and Hospital Variation in Time-to-Antibiotics Among Veterans Hospitalized With Sepsis.

Importance: It is unclear whether antimicrobial timing for sepsis has changed outside of performance incentive initiatives.

Objective: To examine temporal trends and variation in time-to-antibiotics for sepsis in the US Department of Veterans Affairs (VA) health care system.

Design, Setting, And Participants: This observational cohort study included 130 VA hospitals from 2013 to 2018.

Measurement of Sepsis in a National Cohort Using Three Different Methods to Define Baseline Organ Function.

In 2017, the U.S. Centers for Disease Control and Prevention (CDC) developed a new surveillance definition of sepsis, the adult sepsis event (ASE), to better track sepsis epidemiology.

Comparison of Recruitment Strategies for Engaging Older Minority Adults: Results From Take Heart.

Background: Few published studies report lessons learned for recruiting older adults from racial/ethnic minority, low SES communities for behavioral interventions. In this article, we describe recruitment processes and results for Take Heart, a randomized controlled trial testing the effectiveness of an adapted heart disease self-management program for primarily African American, urban, low SES adults 50 years or older living in Detroit.

Methods: Older adults were recruited via community-based (CB), electronic medical record (EMR), and in-person hospital clinic (HC) methods.

Using the Replicating Effective Programs Framework to Adapt a Heart Health Intervention.

Heart disease is the leading cause of death in the United States. African Americans and people of low socioeconomic status suffer disproportionately from heart disease-related morbidity and mortality. In Detroit, Michigan, a primarily African American and low-income urban area, heart disease mortality is at twice the national rate.