Does early follow-up improve the outcomes of sepsis survivors discharged to home health care?
Open accessAbstract
Background: There is little evidence to guide the care of over a million sepsis survivors following hospital discharge despite high rates of hospital readmission. Objective: We examined whether early home health nursing (first visit within 2 days of hospital discharge and at least 1 additional visit in the first posthospital week) and early physician follow-up (an outpatient visit in the first posthospital week) reduce 30-day readmissions among Medicare sepsis survivors. Design: A pragmatic, comparative effectiveness analysis of Medicare data from 2013 to 2014 using nonlinear instrumental variable analysis. Subjects: Medicare beneficiaries in the 50 states and District of Columbia discharged alive after a sepsis hospitalization and received home health care. Measures: The outcomes, protocol parameters, and control variables were from Medicare administrative and claim files and the home health Outcome and Assessment Information Set (OASIS). The primary outcome was 30-day all-cause hospital readmission. Results: Our sample consisted of 170,571 mostly non-Hispanic white (82.3%), female (57.5%), older adults (mean age, 76 y) with severe sepsis (86.9%) and a multitude of comorbid conditions and functional limitations. Among them, 44.7% received only the nursing protocol, 11.0% only the medical doctor protocol, 28.1% both protocols, and 16.2% neither. Although neither protocol by itself had a statistically significant effect on readmission, both together reduced the probability of 30-day all-cause readmission by 7 percentage points (P=0.006; 95% confidence interval=2, 12). Conclusions: Our findings suggest that, together, early postdischarge care by home health and medical providers can reduce hospital readmissions for sepsis survivors.
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Three studies, one RCT and two observational studies, evaluated early post-hospital follow-up in patients with critical illness.
“Three studies, one RCT (628) and two observational studies (629, 630) evaluated early post-hospital follow-up in patients with critical illness.”
From Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock 2021. (2021) · cites this paper as [628]
Reductions in ICU and ventilator days in intervention patients who died before hospital discharge were found in two studies, and a third study found overall shorter ICU and hospital stay in the ethics consultation group.
“Reductions in ICU and ventilator days in intervention patients who died before hospital discharge were found in two studies (539, 540), and the third study found overall shorter ICU and hospital stay in the ethics consultation group (541).”
From Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock 2021. (2021) · cites this paper as [540]
The Methods (Study Population) describe sepsis patients discharged alive to home health care, and the Results (Control Function Modeling Results) assess post-discharge follow-up and 30-day readmission. Searches for ethics consultation, ventilator days, and ICU or hospital length of stay found no passage addressing the attributed findings. Page numbers were not available in our copy. (LLM, conf=0.76)
Experimental — accuracy not yet measuredEthics consultation did not affect overall mortality in any study.
“Ethics consultation did not affect overall mortality in any study.”
From Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock 2021. (2021) · cites this paper as [540]
The Results section, under “Control Function Modeling Results” (page unavailable), reports that early nursing and physician follow-up did not affect rates of hospice admission or death among sepsis survivors. It does not address ethics consultation or mortality across multiple studies. Searches for “ethics consultation” and related mortality terms found no passage supporting the attributed claim. (LLM, conf=0.78)
Experimental — accuracy not yet measuredIn an analysis of older adults with severe sepsis, one study found that early home health care combined with a medical provider visit was associated with reduced readmission risk.
“In an analysis of older adults with severe sepsis, one study found that the combination of early home health care and a visit with a medical provider was associated with a reduced readmission risk [631].”
From Surviving sepsis campaign: international guidelines for management of sepsis and septic shock 2021 (2021) · cites this paper as [631]
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Self-citationBridging the Gap in Sepsis Recovery: A Scoping Review of Post-Discharge Care Interventions
Hanning, R., Meggelen, L. V., Soares, J., Fox‐Robichaud, A., Enns, R., McGillion, M. H., Whitmore, C., & Canada, O. B. O. S. (2026) · Journal of Intensive Care Medicine · doi:10.1177/08850666261451779
Bowles, K. H., Hirschman, K. B., Stawnychy, M. A., O’Connor, M., Mikkelsen, M. E., You, S. B., Sang, E., Oh, S., Pitcher, K. S., Newman, B., et al. (2026) · BMC Health Services Research · doi:10.1186/s12913-026-15118-5
Self-citationBeyond Sepsis Survival: Post‐Acute Vulnerability Profiles in Older Home Health Patients
You, S. B., Song, J., Ryvicker, M. B., Barrón, Y., Quinn, R., Hsu, J. Y., Naylor, M. D., Lasater, K. B., & Bowles, K. H. (2026) · Journal of the American Geriatrics Society · doi:10.1111/jgs.70796
Self-citationYou, S. B., Stawnychy, M. A., Song, J., Hirschman, K. B., O’Connor, M. L., Sang, E., Oh, S., Pitcher, K. S., Garren, P. A., Cueto, S., et al. (2026) · Learning Health Systems · doi:10.1002/lrh2.70130
Self-citation
- Authors
- Deb, P., Murtaugh, C. M., Bowles, K. H., Mikkelsen, M. E., Khajavi, H. N., Moore, S., Barrón, Y., & Feldman, P. H.
- Affiliations
- National Bureau of Economic Research (US)
- VNS Health (US)
- University of Pennsylvania (US)
- The Graduate Center, CUNY (US)
- Independent Contractor, Bonny Doon, California
- Corresponding author
- Deb, Partha
- ORCID
- Venue
- Medical Care
- Published
- 2019-08
- Volume
- 57
- Issue
- 8
- Pages
- 633-640
- ISSN
- 0025-7079 (ISSN-L)
- PMC
- PMC11648946
- OpenAlex
- W2960683087
- Semantic Scholar
- dcb7f7625b633db964d7ff6b71a408c5f6da43ac
- Cited by
- 55
- References
- 31
- Citations by year
- 2026: 4 · 2025: 12 · 2024: 5 · 2023: 5 · 2022: 6 · 2021: 10 · 2020: 12 · 2019: 1
- FWCI
- 5.52
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Medical Care (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institute of Nursing Research (R01NR016014)
- Topics
- Health Sciences › Medicine › Epidemiology › Sepsis Diagnosis and Treatment
- Health Sciences › Medicine › Emergency Medicine › Hospital Admissions and Outcomes
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Heart Failure Treatment and Management
- Keywords
- sepsis survivors, home health care, home care nursing, physician follow-up, hospital readmission, 30-day readmission, post-discharge care, Medicare beneficiaries, severe sepsis, OASIS
- MeSH terms
- Aftercare, Aged, Clinical Protocols, Female, Humans, Male, Patient Discharge, Treatment Outcome, Sepsis, Home Health Nursing
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Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
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