The success of New York’s mandate for protocolized sepsis care offers a nuanced lesson for other states considering similar regulations.
New research published in JAMA finds New York State’s implementation of sepsis regulations in 2013 produced sepsis mortality rates significantly lower than those found in four states that did not implement regulations. Unadjusted 30-day in-hospital mortality rates in New York dropped from 26.3% before the regulations to 22% after the regulations.
Those results add up a win for New York policymakers, according to study author Jeremy Kahn, M.D., M.S., professor of critical care medicine and health policy and management at the University of Pittsburgh. In terms of what guidance New York’s results offer for the dozen or so other states considering similar regulations, however, the lesson is not so straightforward.
“I think this is both reassuring for other states in that they might say, 'Okay, let’s give this a shot.' But at the same time there are some cautionary notes because New York is just a bit of a different animal than other states,” Kahn told FierceHealthcare.
The main reasons results might not be guaranteed in other states fall into two broad categories. First, mortality rates in New York were already higher than most other states, so part of the program’s success could have been related to how far hospitals had to go. For states with low mortality or engaged hospitals, Kahn said such policies may not necessarily move the needle as significantly.
Second, New York’s solution came about in what Kahn calls a “perfect storm” featuring an engaged department of health, active hospital associations and groups who acted as willing partners, plus grassroots advocacy. In particular, he points out that the Rory Staunton Foundation put a public face on a condition that otherwise tends to remain in the shadow of other, higher-profile conditions.
From a policy perspective, the study demonstrates that, under the right circumstances, it’s possible to produce positive changes in the healthcare system through properly administrated regulatory actions. The trick is figuring out how to identify the right targets for those regulations and bringing all the right stakeholders to the table to ensure they’re on board.
“We should all be doing evidenced-based practice, and when we do that, good things happen," Kahn said. “The crux is that professionalism alone doesn’t always motivate us to do the right thing—in almost every field of healthcare there’s examples of how we fail to consistently deliver evidence-based practice. So then it becomes a question of what do we do?”
New York’s solution was revolutionary in that it bypassed softer regulatory possibilities such as public quality reporting or pay-for-performance incentives and opted instead for a straight mandate. Kahn points out that mandating best practices is an invasive approach that potentially has unintended consequences, so policymakers ought to consider it with some caution.
“We can’t be giving hospitals a laundry list of 800 conditions, each needing a custom-made, highly tailored initiative—we have to focus on the most important thing,” Kahn said. “If you’re going to focus on something, though, sepsis is quite a reasonable thing to focus on—it’s a high-incidence condition, it’s the most expensive condition in U.S. hospitals and it’s killing tens of thousands of people each year.”