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The Impact of the Bundled Payment for Care Improvement Advanced on Outcomes for Patients with Sepsis

Award Number: R01HL160588
ORGANIZATION: NATIONAL HEART, LUNG, & BLOOD INSTITUTE
OPDIV: NIH
AWARD CLASS: DISCRETIONARY
AWARD ACTIVITY TYPE: SCIENTIFIC/HEALTH RESEARCH (INCLUDES SURVEYS)
PERIOD OF PERFORMANCE START DATE: 12/25/2022
PERIOD OF PERFORMANCE END DATE: 11/30/2026

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The Impact of the Bundled Payment for Care Improvement Advanced on Outcomes for Patients with Sepsis - PROJECT SUMMARY Sepsis is a devastating condition resulting from the immune system’s reaction to infection. 1.7 million Americans are hospitalized annually with sepsis, resulting in over 270,000 deaths. Sepsis is more common among older patients, leading to spending among Medicare beneficiaries totaling $41B in 2018. Treatment costs and episode spending also vary widely across hospitals, driven largely by differences in post-acute care. In an attempt to improve care, sepsis was included as one of the 31 inpatient episodes targeted under Medicare’s Bundled Payment for Care Improvement Advanced (BPCI-A) program. BPCI-A is a voluntary program that creates incentives for hospitals to improve patient outcomes and reduce spending across a 90- day post-discharge episode. BPCI-A has the potential to encourage hospitals to more effectively manage patients during the admission to avoid subsequent complications and to discharge patients to lower acuity post-acute settings. At the same time, BPCI-A is not designed primarily to improve quality, and changes in patient outcomes – positive or negative – will be closely tied to hospital efforts to reduce spending. Patients with Alzheimer’s disease and related dementias (ADRD) are both more likely to develop sepsis and to have worse outcomes. Patients with ADRD have very high episode spending and are particularly vulnerable to adverse outcomes following discharge, making their treatment for sepsis under BPCI-A critically important to understand. Outside of ADRD, how patient risk and sepsis care pathways influence patient outcomes for sepsis in the context of BPCI-A are not well understood. In this context, we propose the following aims: Aim 1. Evaluate the effects of BPCI-A on outcomes for patients with sepsis. We will link hospital participation in BPCI- A with national Medicare data to test the effects of the program on mortality, readmission, post-acute care, days alive and at home, burdensome transitions, and discharge to hospice. Aim 2. Evaluate the effects of BPCI-A on outcomes for sepsis patients with ADRD. Using validated Medicare claims algorithms to identify patients with ADRD, we will test the impact of BPCI-A on outcomes for patients with ADRD. Aim 3. Understand the relationship between clinical risk, treatment, and post-acute care treatment patterns and outcomes under BPCI-A. Using unique data from the Michigan Sepsis Initiative linked to Medicare claims data, we will identify the clinical treatment patterns, patient risk factors, and hospital characteristics that predict patient outcomes. We will examine whether hospitals participating in BPCI-A deploy a different set of strategies to manage patients with sepsis. Our proposal is significant because it combines national data with detailed clinical insights to understand the interplay between national policy and nuanced clinical care for patients with sepsis. Our proposal is innovative in its combination of administration and registry data sources coupled with sophisticated quantitative methods to answer a novel question.


Issue Date FY	Funding FY	Legal Entity Name	Legal Entity Address	Legal Entity City	Legal Entity State	Legal Entity Zip Code	Legal Entity COUNTY	Legal Entity COUNTRY	Assistance Listing	Award Code	Budget Year	Action Date	Action Type	Action Amount

Issue Date FY: 2026 ( Subtotal = $584,411 )
2026	2026	BROWN UNIVERSITY	1 PROSPECT ST	PROVIDENCE	RI	02912	PROVIDENCE	USA	Translation and Implementation Science Research for Heart, Lung, Blood Diseases, and Sleep Disorders	001	4	3/23/2026	NON-COMPETING CONTINUATION	$17,890
2026	2026	BROWN UNIVERSITY	1 PROSPECT ST	PROVIDENCE	RI	02912	PROVIDENCE	USA	Translation and Implementation Science Research for Heart, Lung, Blood Diseases, and Sleep Disorders	000	4	2/18/2026	NON-COMPETING CONTINUATION	$566,521
														Subtotal = $584,411

Issue Date FY: 2025 ( Subtotal = $604,028 )
2025	2025	BROWN UNIVERSITY	1 PROSPECT ST	PROVIDENCE	RI	02912	PROVIDENCE	USA	Translation and Implementation Science Research for Heart, Lung, Blood Diseases, and Sleep Disorders	000	3	1/22/2025	NON-COMPETING CONTINUATION	$543,626
2025	2025	BROWN UNIVERSITY	1 PROSPECT ST	PROVIDENCE	RI	02912	PROVIDENCE	USA	Translation and Implementation Science Research for Heart, Lung, Blood Diseases, and Sleep Disorders	002	3	8/4/2025	NON-COMPETING CONTINUATION	$60,402
2025	2023	REGENTS OF THE UNIVERSITY OF MICHIGAN	1109 GEDDES AVE STE 3300	ANN ARBOR	MI	48109	WASHTENAW	USA	Translation and Implementation Science Research for Heart, Lung, Blood Diseases, and Sleep Disorders	001	1	2/14/2025	NEW	$0
														Subtotal = $604,028

Issue Date FY: 2024 ( Subtotal = $546,351 )
2024	2024	BROWN UNIVERSITY	1 PROSPECT ST	PROVIDENCE	RI	02912	PROVIDENCE	USA	Translation and Implementation Science Research for Heart, Lung, Blood Diseases, and Sleep Disorders	001	2	4/16/2024	CHANGE OF GRANTEE / TRAINING INSTITUTION / AWARDING INSTITUTION	$546,351
2024	2023	REGENTS OF THE UNIVERSITY OF MICHIGAN	1109 GEDDES AVE, SUITE 3300	ANN ARBOR	MI	48109	WASHTENAW	USA	Translation and Implementation Science Research for Heart, Lung, Blood Diseases, and Sleep Disorders	000	1	4/15/2024	NEW	$0
														Subtotal = $546,351

Issue Date FY: 2023 ( Subtotal = $721,155 )
2023	2023	REGENTS OF THE UNIVERSITY OF MICHIGAN	503 THOMPSON ST	ANN ARBOR	MI	48109	WASHTENAW	USA	Translation and Implementation Science Research for Heart, Lung, Blood Diseases, and Sleep Disorders	000	1	12/23/2022	NEW	$721,155
														Subtotal = $721,155

Grand Total All Awards = $2,455,945

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The Impact of the Bundled Payment for Care Improvement Advanced on Outcomes for Patients with Sepsis

Award Number: R01HL160588

ORGANIZATION: NATIONAL HEART, LUNG, & BLOOD INSTITUTE

OPDIV: NIH

AWARD CLASS: DISCRETIONARY

AWARD ACTIVITY TYPE: SCIENTIFIC/HEALTH RESEARCH (INCLUDES SURVEYS)

PERIOD OF PERFORMANCE START DATE: 12/25/2022

PERIOD OF PERFORMANCE END DATE: 11/30/2026

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