The German Quality Network Sepsis: Evaluation of a Quality Collaborative on Decreasing Sepsis-Related Mortality in a Quasi-Experimental Difference-in-Differences Design

BackgroundSepsis is one of the leading causes of preventable deaths in hospitals. This study presents the evaluation of a quality collaborative network, which aimed to decrease sepsis-related hospital mortality.MethodsThe German Quality Network Sepsis (GQNS) offers quality reporting based on claims data, peer reviews, and support for establishing continuous quality improvement and staff education to participating hospitals. The primary outcome of the evaluation was all-cause risk-adjusted hospital mortality among cases with sepsis per hospital. Sepsis was identified by ICD-10 codes in claims data for sepsis with organ dysfunction or septic shock according to the sepsis-1 definition. To evaluate the effect of the GQNS, the change in outcomes from a retrospective baseline (January 2014 – March 2016) to the intervention phase (April 2016 – June 2018) was compared between the hospitals in the GQNS and the national German diagnosis-related-groups statistics. Tests were conducted by interrupted time-series analyses using hierarchical models. Implementation processes and barriers were assessed by a survey of local leaders of quality improvement teams in autumn 2018.ResultsSeventy-four hospitals participated, of which 17 were university hospitals and 18 were tertiary care facilities. Observed mortality was 43.5% during baseline period and 42.7% during intervention period. Interrupted time-series analyses did not show effects on course or level of risk-adjusted mortality of cases with sepsis compared to the national DRG-statistics after the beginning of the intervention period (p=0.632, and p=0.512, respectively). There were also no significant effects in the subgroups of patients with septic shock or ventilation >24h or subgroups of hospitals. Surveys among 48 local quality improvement leaders revealed that most hospitals did not succeed in implementing a continuous quality improvement program or relevant measures to improve early recognition and treatment of sepsis. Barriers perceived most commonly were lack of time (77.6%), staff shortage (59.2%), and lack of participation of relevant departments (38.8%).ConclusionsAs long as hospital-wide sepsis quality improvement efforts will not become a high priority for the hospital leadership by assuring adequate resources and involvement of all pertinent stakeholders, voluntary initiatives to improve the quality of sepsis care will remain prone to failure.