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Electronic Surveillance for Hospital-Onset Sepsis to Expand Detection of Serious Healthcare-Associated Infections

Award Number: R01HS029660
ORGANIZATION: AGENCY FOR HEALTH CARE RESEARCH AND QUALITY
OPDIV: AHRQ
AWARD CLASS: DISCRETIONARY
AWARD ACTIVITY TYPE: SCIENTIFIC/HEALTH RESEARCH (INCLUDES SURVEYS)
PERIOD OF PERFORMANCE START DATE: 09/30/2023
PERIOD OF PERFORMANCE END DATE: 07/31/2028

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Electronic Surveillance for Hospital-Onset Sepsis to Expand Detection of Serious Healthcare-Associated Infections - PROJECT ABSTRACT Healthcare-associated infections (HAIs) are a leading cause of preventable harm in U.S. hospitals. Hospitals are therefore required to report selected HAIs, including central line-associated bloodstream infections, catheter-associated urinary tract infections, colon and abdominal hysterectomy surgical site infections, methicillin-resistant Staphylococcus aureus bacteremia, and Clostridioides difficile infections, to the Centers for Medicare & Medicaid Services (CMS) via CDC’s National Healthcare Safety Network. These data are used to benchmark hospitals and to inform CMS’s pay-for performance programs. In many cases, however, conducting surveillance for HAIs is complicated, resource intensive, and prone to high levels of interobserver variability. Furthermore, many of the most common and morbid HAIs, such as hospital-acquired pneumonia and most non-line associated bloodstream infections, are not routinely tracked or reported and are therefore largely neglected by hospitals. Our underlying hypothesis is that electronic surveillance for hospital-onset sepsis could provide a more complete, efficient, and objective method to identify a fuller array of the most serious HAIs compared to current surveillance methods. In particular, CDC’s hospital-onset Adult Sepsis Event definition uses routine electronic clinical data to identify patients with concurrent clinical indicators of presumed serious infections (blood culture orders and antibiotic treatment) and concurrent organ dysfunction (initiation of vasopressors or mechanical ventilation or significant changes in laboratory values). Preliminary data suggest that CDC’s hospital-onset sepsis surveillance definition may identify many more HAIs than current CMS reportable metrics and that hospital-onset sepsis is associated with very high mortality rates even when reportable HAIs are absent. Before hospitals and policymakers consider routinely tracking hospital-onset sepsis, however, data from diverse settings are needed to understand its incidence and variation across hospitals, its impact on long-term outcomes, and the specific infections leading to sepsis. This proposal will address these gaps through the following Specific Aims: 1) Characterize the incidence, in-hospital mortality, and hospital-level variation for hospital-onset sepsis versus currently reportable HAIs, 2) Determine the impact of hospital-onset sepsis versus reportable HAIs on patients’ long-term outcomes, and 3) Develop electronic algorithms using clinical and administrative data to automatically identify the types of infections precipitating hospital-onset sepsis. This work will be conducted using detailed clinical data from 145 HCA Healthcare hospitals that collectively care for more than 1.7 million inpatients per year (approximately 5% of U.S. acute care hospitalizations). In Aim 2, we will also link HCA data to CMS claims data to accurately capture post- discharge outcomes for Medicare beneficiaries. This proposal directly addresses the goals of AHRQ and its HAI Prevention Portfolio by providing the foundation for a new HAI surveillance paradigm that will help identify new targets for prevention and quality improvement and thereby help catalyze better outcomes for patients.


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: 2025 ( Subtotal = $570,137 )
2025	2025	HARVARD PILGRIM HEALTH CARE INC	1 WELLNESS WAY	CANTON	MA	02021	NORFOLK	USA	Research on Healthcare Costs, Quality and Outcomes	002	3	9/29/2025	NON-COMPETING CONTINUATION	$473,278
2025	2025	HARVARD PILGRIM HEALTH CARE INC	1 WELLNESS WAY	CANTON	MA	02021	NORFOLK	USA	Research on Healthcare Costs, Quality and Outcomes	001	2	12/5/2024	SUPPLEMENT FOR EXPANSION	$96,859
2025	2024	HARVARD PILGRIM HEALTH CARE INC	1 WELLNESS WAY	CANTON	MA	02021	NORFOLK	USA	Research on Healthcare Costs, Quality and Outcomes	000	2	11/20/2024	NON-COMPETING CONTINUATION	$0
														Subtotal = $570,137

Issue Date FY: 2024 ( Subtotal = $484,297 )
2024	2024	HARVARD PILGRIM HEALTH CARE INC	1 WELLNESS WAY	CANTON	MA	02021	NORFOLK	USA	Research on Healthcare Costs, Quality and Outcomes	001	2	7/25/2024	NON-COMPETING CONTINUATION	$484,297
2024	2023	HARVARD PILGRIM HEALTH CARE INC	1 WELLNESS WAY	CANTON	MA	02021	NORFOLK	USA	Research on Healthcare Costs, Quality and Outcomes	000	1	11/28/2023	NEW	$0
														Subtotal = $484,297

Issue Date FY: 2023 ( Subtotal = $495,492 )
2023	2023	HARVARD PILGRIM HEALTH CARE INC	1 WELLNESS WAY	CANTON	MA	02021	NORFOLK	USA	Research on Healthcare Costs, Quality and Outcomes	000	1	9/8/2023	NEW	$495,492
														Subtotal = $495,492

Grand Total All Awards = $1,549,926

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Electronic Surveillance for Hospital-Onset Sepsis to Expand Detection of Serious Healthcare-Associated Infections

Award Number: R01HS029660

ORGANIZATION: AGENCY FOR HEALTH CARE RESEARCH AND QUALITY

OPDIV: AHRQ

AWARD CLASS: DISCRETIONARY

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

PERIOD OF PERFORMANCE START DATE: 09/30/2023

PERIOD OF PERFORMANCE END DATE: 07/31/2028

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