HCA Healthcare - Harvard Pilgrim Health Care Institute Partnership

Project Summary

Since 2008, we have partnered with HCA Healthcare and its 180+ hospitals to conduct both observational studies and cluster-randomized clinical trials focused on

Surveillance and prevention of healthcare associated infections
Epidemiology of community- and hospital-acquired sepsis
Antimicrobial stewardship
Pandemic responsiveness

These studies have informed national estimates of disease burden and have changed national practice regarding infection prevention. Results of all studies are published, often in high-impact journals (e.g., NEJM, Lancet, JAMA).

Funders

Agency for Healthcare Research and Quality (AHRQ)
Centers for Disease Control and Prevention (CDC)
Food and Drug Administration (FDA)
HCA Healthcare
National Institutes of Health (NIH)

Investigators

Richard Platt
Michael Klompas
Chanu Rhee
Meghan Baker
Susan Huang (University of California - Davis)
Ed Septimus (HCA Healthcare)
Ken Sands (HCA Healthcare)
Russell Poland (HCA Healthcare)
Jeff Guy (HCA Healthcare)

Portfolio Details

INSPIRE I and II: 59- and 92-hospital cluster randomized trials of Computerized Prescriber Order Entry (CPOE) prompts reduced unnecessary empiric prescribing of extended spectrum antimicrobials by 21-35% for patients hospitalized with community-acquired pneumonia, urinary tract infection, intra-abdominal infection, or skin/soft tissue infection.

Surveillance for Non-Ventilator Hospital Acquired Pneumonia (NV-HAP): This 284-hospital retrospective cohort analysis (HCA and Veterans Health Administration hospitals) tested a novel electronic surveillance definition to identify NV-HAP, quantify its incidence, and describe the characteristics and outcomes of patients with NV-HAP. We estimated that NV-HAP accounts for 1 in 14 hospital deaths.
NEVER: This ~150-hospital quality improvement initiative is working to reduce NV-HAP by increasing the frequency of daily oral care and patient mobility. Click here for more information.

Pandemic preparedness: These studies addressed the ability of HCA Healthcare to address key public health surveillance needs. These were conducted as part of FDA’s Sentinel System activities.
- Influenza: A study funded by FDA’s Office of Counterterrorism and Emergency Preparedness (OCET) used data from ~140 HCA hospitals to assess the feasibility of using HCA data for medical countermeasures during public health emergencies, with influenza as a use case. Reports were developed describing clinical characteristics and outcomes of hospitalized influenza cases, showcasing ability to use this data to inform FDA on patient care, patient characteristics and medication use, and generally that these systems can provide timely information during public health emergencies. Click here for more information.
- COVID-19: As part of the Sentinel System Enhancements to support pandemic preparedness efforts, use of data from ~140 HCA hospitals was funded to support timely evidence generation during the COVID-19 pandemic. This included monitoring trends and describing clinical characteristics, conditions, complications, treatments and outcomes among hospitalized COVID-19 patients, as well as describing temporal and regional patterns of inpatient drug utilization during the early pandemic. Click here for more information.

Sepsis Incidence, Mortality, and Trends in US Hospitals: A 409-hospital retrospective cohort study including 137 HCA Healthcare hospitals is regularly cited by CDC as the best data on national trends in the incidence and outcomes of sepsis. Using objective clinical measures rather than administrative claims, this study estimated that sepsis affects 1.7 million adults per year, contributing to over 270,000 deaths, and that the incidence of sepsis and related mortality was stable between 2009-2014.
Sepsis Time Zero: This retrospective cohort study, using data from 146 HCA Healthcare hospitals, is developing computable definitions of sepsis “time zero” to identify patients in the Emergency Department with possible infection who require immediate antibiotics for sepsis care. Click here for more information.
Development of a National Pediatric Sepsis Event Surveillance Definition: this study is developing and validating an EHR-based Pediatric Sepsis Event surveillance definition to estimate the national burden of pediatric sepsis using EHR datasets (including 146 HCA Healthcare hospitals). Click here for more information.
Reliability and Validity Testing for a Risk-Adjusted Community-Onset Adult Sepsis Event Definition: To support the submission of a risk-adjusted sepsis mortality quality measure based on an updated Adult Sepsis Event (ASE) definition for the CMS Measures Under Consideration (MUC) list, data from HCA Healthcare (146 hospitals), PINC AI and Mass General Brigham are currently being analyzed.

CLUSTER: An 82-hospital cluster randomized trial of early detection of outbreaks in hospitals using automated surveillance for statistically unusual clusters of hospital-acquired infections, coupled with a robust response protocol, found a 64% reduction in additional cases during the pre-COVID period.
Surveillance for Hospital-Onset Sepsis to Detect Serious Healthcare-Associated Infections (HAIs): This 146-hospital retrospective cohort study is leveraging CDC’s hospital-onset Adult Sepsis Event surveillance definition to characterize the incidence, outcomes, and overlap of hospital-onset sepsis with current reportable HAIs across 145 HCA hospitals; elucidate their impact on long-term outcomes; and develop electronic algorithms to identify infections leading to hospital-onset sepsis. Click here for more information.

REDUCE: A 43-hospital cluster randomized trial demonstrated the value in ICU patients chlorhexidine bathing and intranasal mupirocin to prevent methicillin resistant S. aureus (MRSA) infections and all-cause bloodstream infections.
ABATE: A 53-hospital cluster randomized trial demonstrated the value of decolonization in non-ICU patients with vascular catheters and devices.
SWAPOUT: A 137-hospital randomized trial demonstrated that nasal mupirocin was superior to nasal iodophor, and that iodophor was superior to no nasal component, as part of a universal decolonization regimen in ICU patients.