Becker's Hospital Review

31 QUALITY IMPROVEMENT & MEASUREMENT UPMC gets $3.7M to improve care for sepsis, pneumonia survivors By Anuja Vaidya U PMC received $3.7 million in funds from a patient care research organiza- tion to compare the effectiveness of strategies that support sepsis survivors and people recovering from severe pneumonia. e study will be conducted over the next three years by the UPMC Center for High-Value Health Care, a nonprofit research organization, in collaboration with the University of Pittsburgh School of Medicine's department of critical care medicine. e Patient-Centered Outcomes Research Insti- tute, an independent, nonprofit authorized by Congress in 2010, awarded the grant money. e study will focus on testing care strategies to identify ones that will help better manage patients who have survived sepsis and severe pneumonia and have le the hospital. e study aims to enroll more than 1,600 participants who will undergo different types of interventions once they have returned home from the hospital. Clinicians will mon- itor their progress remotely. "More and more, people are surviving sepsis. But that's not enough, we want them to thrive," said Sachin Yende, MD, MS, pro- fessor of critical care medicine and clinical and transitional science at the University of Pittsburgh and co-leader of the study. "is trial will test several at-home interventions and as it progresses increase the number of patients we enroll in the better performing arms of the study while phasing out the less successful interventions." n 28% of antibiotics prescribed without in-person visits for Medicaid patients By Gabrielle Masson M ore than a quarter of outpatient prescriptions for anti- biotics among Medicaid recipients were not associated with a clinic visit, according to a study published Feb. 3 in Health Affairs. Researchers analyzed 2004-13 Medicaid claims data of 298 mil- lion antibiotic fills — 62 percent of which were for children — for 53 million patients. The study found 55 percent of antibiotic fills were for clinician visits with an infection-related diagnosis, 17 percent were for clinician visits without an infection-related diag- nosis and 28 percent were prescribed without an in-person visit. About half of the prescriptions occurring without a clinic visit were associated with laboratory testing or home care services. Children were less likely than adults to be prescribed antibiot- ics without a clinic visit. The findings could mean antibiotic stewardship efforts aimed at reducing inappropriate prescribing miss a large percentage of prescriptions. "We're not saying that every one of these antibiotic prescriptions is clinically inappropriate or problematic … but we are saying that we all need to look carefully at what's going on," Michael Fischer, MD, study author and associate professor of medicine at Bos- ton-based Harvard Medical School, told Medscape. "We need to figure out whether this could be contributing to overuse and the problems that result from overuse." n Sepsis guidelines established for pediatric patients By Mackenzie Bean T he Surviving Sepsis Campaign on Feb. 7 published new guidelines for diagnosing and treating sepsis in pediatric patients. Unlike adults, children don't typically expe- rience low blood pressure — a sign of septic shock — until later stages of the illness. There- fore, the guidelines outline a two-phase process to help providers screen children who may have sepsis. Children who display symptoms of septic shock should start antibiotics within one hour of de- tection, according to the guidelines. Children who don't have initial symptoms should be further evaluated for sepsis, and, if di- agnosed, receive antibiotics within three hours of their first screening. The guidelines also recommend providers ob- tain blood cultures before starting antibiotics, as long as the testing does not substantially delay treatment. The guidelines were published in the journals Pediatric Critical Care Medicine and Intensive Care Medicine. n

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