A Whole-of-Hospital Value-Driven Outcomes Approach to Optimize Clinical Outcomes and Minimize Hospitalization for Community-Acquired Sepsis

Abstract

Summary Sepsis is a high-cost, high-prevalence condition. However, treatment of this condition by frontline clinicians varies across institutions. The traditional fee-for-service model that incentivizes quantity over quality of care would lead to unsustainable cost escalation over time. In contrast, the value-driven outcomes (VDO) approach recognizes value enhancement by both outcome improvement and cost reduction. Another key principle of this approach is the organization of multidisciplinary care around a central condition of concern. For the authors, multidisciplinary extends through the whole hospital, involving the ED, inpatient care units, education units, the antimicrobial stewardship program, the bed management unit, and the medical informatics unit. Through the application of evidence-based practices along the continuum of sepsis care, Singapore’s National University Hospital whole-of-hospital VDO approach contributed to improving key clinical process measures and maintaining low mortality and readmission rates while reducing hospital length of stay. It saved U.S. $5.7 million per year for about 2,000 patients annually from 2019 to 2021. These robust improvements occurred despite health care system strain imposed by the Covid-19 pandemic.