Home Care Solutions for Health Disparities, Better Outcomes on Sepsis Care

Two new reports on New York’s hospital-based sepsis regulations reveal promising results as well as opportunities for better outcomes that are possible through HCA-advanced legislation to support sepsis screening by home care providers and partners.

One study, from the Journal of the American Medical Association, finds that the six-year-old hospital sepsis rules — known as Rory’s Regulations, named after Rory Staunton, a young boy who succumbed to the condition in 2012 — have led to a 3.2 percent drop in mortality in New York compared to other states without protocols. HCA applauds the hospitals, Department of Health and the Stauntons who worked hard to achieve these improvements.

The second study, reported in Health Affairs, finds that some hospitals may not be uniformly applying the protocols in all communities, suggesting the need for more data analysis and process improvements to overcome racial disparities in sepsis treatment procedures.

Enter home care.

HCA’s home-based sepsis screening tool is being used by agencies across New York (and nationally) to screen thousands of patients for pre-hospital sepsis risk. It is creating a new primary layer of sepsis intervention never before had in the system.

The program, Stop Sepsis at Home NY, was bolstered by state legislation (A.3839/S.1817) that passed both houses in June. If signed by Governor Cuomo as we hope, this legislation will not only incentivize broader use of the screening tool. It also helps hospitals improve their own outcomes — and save lives — in several ways. Foremost, it will drive early recognition leading to immediate treatment at home or timely referral to the ER. In so doing, it will also provide a larger set of available pre-hospital admission information that is synchronized between home care providers and hospitals regarding a patient’s systemic criteria for sepsis follow-up care once the patients reaches the hospital’s door. This same synchronization can occur for sepsis patients being discharged from the hospital to the home care provider for after-care.

These are just some of the ways that A.3839/S.1817 would improve sepsis outcomes and combat disparities that may otherwise occur in hospitals due to the short, time-sensitive and urgent window of action and intervention for sepsis in an acute-care hospital episode. Indeed, a patient in home care has longer-term exposure to clinicians who connect with patients culturally, socially, environmentally and (often) linguistically (in the case of non-English-speaking clients) over a period of time, both pre-hospital and post-hospital, to help broaden the course of treatment — and to do so cost-effectively.

With all manner of policymaking, supports for home care also provide help for hospitals in the form of better community-sourced information about a patient’s clinical history, home care’s ability to stem avoidable inpatient utilization or lengths of stay, ER avoidance, and improved readmission rates. HCA’s sepsis legislation is no different, especially given that the in-home sepsis screening tool supported by A.3839/S.1817 was developed in consultation with leading sepsis medical experts from the hospital setting who took great care to align all elements of the home care tool with hospital protocols for the sake of seamless coordination of care.

In short, countless home care clinician managers acting on these protocols, collecting and delivering pre-admission assessments, will be a major contributor to improved outcomes across settings.

How home care addresses other disparity-prone conditions

Procedures, like the home care and hospital sepsis protocols, are inextricably linked with outcomes. Better procedures lead to better outcomes; and we know from various studies that racial disparities in sepsis care are not just procedural, as the Health Affairs article reports, but also outcome based, which is why procedures and outcomes need to be aligned.

According to another study, Black and Hispanic populations frequently exhibit higher rates of morbidity and mortality due to sepsis. The study offers recommendations ranging from early identification to better clinical management of sepsis.

These recommendations are applicable to a range of other disparity-prone conditions, which is why HCA advanced a pioneering health disparities bill this past legislative session (A.6772/S.4942) to utilize the core strengths of home care, as outlined above, in the form of expanded collaborative programs with hospitals and primary care to address health care disparities based on social, economic or environmental disadvantage.

Home care providers work directly in a patient’s personal and cultural surroundings. Caregivers are trained in cultural competencies. Their disease-management role is directed squarely to many of the most disparity-prone conditions that plague New Yorkers.

As we urge Governor Cuomo to sign the home care sepsis legislation into law, HCA will be working with bill sponsors and prospective cosponsors to move forward on a disparities effort in the coming state budget and legislative session to improve care access, procedures and outcomes for all New Yorkers.