OBJECTIVE To profile the characteristics of growing numbers of sepsis survivors receiving home healthcare (HHC) by type of sepsis before, during, and after a sepsis hospitalization and identify characteristics significantly associated with 7-day readmission. DESIGN Cross-sectional descriptive study. Data sources included the Outcome and Assessment Information Set (OASIS) and Medicare administrative and claims data. SETTING AND PARTICIPANTS National sample of Medicare beneficiaries hospitalized for sepsis who were discharged to HHC between July 1, 2013 and June 30, 2014 (N = 165,228). METHODS We used an indicator distinguishing among 3 types of sepsis: explicitly coded sepsis diagnosis without organ dysfunction; severe sepsis with organ dysfunction; and septic shock. We compared these subgroups' demographic, clinical and functional characteristics, comorbidities, risk factors for rehospitalization, characteristics of the index hospital stay, and predicted 7-day hospital readmission. RESULTS The majority (80.7%) had severe sepsis, 5.7% had septic shock, and 13.6% had sepsis without acute organ system dysfunction. The medical diagnoses recorded at HHC admission identified sepsis or blood infection only 7% of the time, potentially creating difficulty identifying the sepsis survivor in HHC. Among sepsis types, septic shock survivors had the greatest illness burden profile. This study describes 12 key variables, each of which individually raises the relative 7-day readmission risk by as much as 60%. Increased risk of 7-day rehospitalization was found among those with septic shock, 3 or more previous inpatient stays, index hospital length of stay of >8 days, dyspnea, >6 functional dependencies, and other risk factors. CONCLUSIONS AND IMPLICATIONS Implications for practice include using our findings to identify sepsis survivors who are at risk for early readmission. Assessment for these factors may profile the at-risk patient, thereby triggering the call for additional acute care intervention such as delayed discharge, or post-acute intervention such as early home visit and outpatient follow-up.

中文翻译：

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脓毒症幸存者过渡到家庭医疗保健：特征和早期再入院风险因素

目的 分析脓毒症住院前、住院期间和住院后接受家庭医疗保健 (HHC) 的脓毒症幸存者数量不断增加的特征，并确定与 7 天再入院显着相关的特征。设计 横断面描述性研究。数据来源包括结果和评估信息集 (OASIS) 以及医疗保险管理和索赔数据。设置和参与者 2013 年 7 月 1 日至 2014 年 6 月 30 日期间因败血症住院的 Medicare 受益人的全国样本（N = 165,228）。方法 我们使用一个指标来区分 3 种类型的脓毒症：明确编码的脓毒症诊断，无器官功能障碍；伴有器官功能障碍的严重脓毒症；和感染性休克。我们比较了这些亚组的人口统计数据，临床和功能特征、合并症、再住院的危险因素、指标住院时间的特征和预测的 7 天再入院。结果 大多数（80.7%）有严重脓毒症，5.7%有感染性休克，13.6%有脓毒症但没有急性器官系统功能障碍。HHC 入院时记录的医学诊断仅 7% 的时间确定了败血症或血液感染，这可能会导致难以在 HHC 中识别败血症幸存者。在脓毒症类型中，感染性休克幸存者的疾病负担最重。该研究描述了 12 个关键变量，每个变量都将相对 7 天再入院风险提高了 60%。在感染性休克、之前住院 3 次或以上、住院时间指数 > 的患者中发现 7 天再住院的风险增加 8 天、呼吸困难、>6 种功能依赖性和其他危险因素。结论和意义 对实践的意义包括使用我们的发现来识别有早期再入院风险的败血症幸存者。对这些因素的评估可能会分析有风险的患者，从而引发对额外的急性护理干预（例如延迟出院）或急性后干预（例如早期家访和门诊随访）的呼吁。