{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,17]],"date-time":"2026-10-17T13:02:06Z","timestamp":1792242126781,"version":"4.4.0"},"reference-count":36,"publisher":"American Medical Association (AMA)","issue":"10","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Intern Med"],"published-print":{"date-parts":[[2025,10,1]]},"abstract":"<jats:sec><jats:title>Importance<\/jats:title><jats:p>Sepsis survivors experience high morbidity and mortality after discharge, but health systems lack effective approaches to improve recovery.<\/jats:p><\/jats:sec><jats:sec><jats:title>Objective<\/jats:title><jats:p>To evaluate the effect of a sepsis transition and recovery (STAR) program compared with usual care on postdischarge outcomes.<\/jats:p><\/jats:sec><jats:sec><jats:title>Design, Setting, and Participants<\/jats:title><jats:p>The ENCOMPASS (Engagement and Collaborative Management to Proactively Advance Sepsis Survivorship) stepped-wedge cluster randomized clinical trial was conducted among adults hospitalized with sepsis at 7 US hospitals in a single health care system from July 2020 to June 2023. Each hospital was a cluster, with 1 randomly transitioning to STAR every 4 months. Follow-up ended in December 2023.<\/jats:p><\/jats:sec><jats:sec><jats:title>Interventions<\/jats:title><jats:p>The STAR program was a navigator-led, telehealth-based strategy to proactively deliver evidence-driven postsepsis care to high-risk patients for 90 days after discharge.<\/jats:p><\/jats:sec><jats:sec><jats:title>Main Outcomes and Measures<\/jats:title><jats:p>The primary outcome was the composite of all-cause hospital readmission or mortality within 90\u2009days of discharge.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Of 3548 patients enrolled, 1843 (52%) were women, and the median (IQR) age was 68 (57-77) years; 1160 (33%) were admitted to the intensive care unit. A total of 1426 patients were randomized to the usual care group and 2122 patients were randomized to the STAR group. In the STAR group, 1393 patients (66%) engaged with the STAR program at least once after discharge. The composite all-cause readmission or mortality at 90 days did not differ between the STAR and usual care groups (1023 [48.2%] vs 684 [48.0%]; adjusted odds ratio, 1.05; 95% CI, 0.90-1.24; <jats:italic>P<\/jats:italic>\u2009=\u2009.53). Analysis of the outcomes separately demonstrated a lower frequency of death among patients in the STAR group compared with those in the usual care group (367 [17.3%] vs 292 [20.5%]; adjusted odds ratio, 0.88; 95% CI, 0.77-0.99; <jats:italic>P<\/jats:italic>\u2009=\u2009.04) and a higher frequency of readmission among patients in the STAR group (763 [35.9%] vs 478 [33.5%]; adjusted odds ratio, 1.13; 95% CI, 0.92-1.38; <jats:italic>P<\/jats:italic>\u2009=\u2009.24).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions and Relevance<\/jats:title><jats:p>In this randomized clinical trial, a multicomponent, navigator-led STAR program did not reduce the composite of all-cause readmission and mortality at 90 days after discharge.<\/jats:p><\/jats:sec><jats:sec><jats:title>Trial Registration<\/jats:title><jats:p>ClinicalTrials.gov Identifier: <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"https:\/\/clinicaltrials.gov\/study\/NCT04495946\">NCT04495946<\/jats:ext-link><\/jats:p><\/jats:sec>","DOI":"10.1001\/jamainternmed.2025.3699","type":"journal-article","created":{"date-parts":[[2025,8,11]],"date-time":"2025-08-11T15:00:41Z","timestamp":1754924441000},"page":"1238","source":"Crossref","is-referenced-by-count":18,"title":["Proactive Telehealth-Based Sepsis Transition and Recovery Support, Hospital Readmission, and Mortality"],"prefix":"10.1001","volume":"185","author":[{"given":"Stephanie Parks","family":"Taylor","sequence":"first","affiliation":[{"name":"Division of Hospital Medicine, University of Michigan, Ann Arbor"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tara","family":"Eaton","sequence":"additional","affiliation":[{"name":"Center for Health System Sciences, Atrium Health, Charlotte, North Carolina"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aleta","family":"Rios","sequence":"additional","affiliation":[{"name":"Clinical Care Management, Atrium Health, Charlotte, North Carolina"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Desiree","family":"Boyd","sequence":"additional","affiliation":[{"name":"Clinical Care Management, Atrium Health, Charlotte, North Carolina"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hazel","family":"Tapp","sequence":"additional","affiliation":[{"name":"Department of Family Medicine, Wake Forest School of Medicine, Charlotte, North Carolina"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew","family":"McWilliams","sequence":"additional","affiliation":[{"name":"Information Technology, Advocate Health, Charlotte, North Carolina"},{"name":"Department of Internal Medicine, Atrium Health, Charlotte, North Carolina"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shih-Hsiung","family":"Chou","sequence":"additional","affiliation":[{"name":"Enterprise Data Science, Advocate Health, Charlotte, North Carolina"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Scott","family":"Halpern","sequence":"additional","affiliation":[{"name":"Palliative and Advanced Illness Research (PAIR) Center, Perelman School of Medicine, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Derek C.","family":"Angus","sequence":"additional","affiliation":[{"name":"Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lewis","family":"McCurdy","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases, Atrium Health, Charlotte, North Carolina"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Asha","family":"Ganesan","sequence":"additional","affiliation":[{"name":"Center for Health System Sciences, Atrium Health, Charlotte, North Carolina"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hieu","family":"Nguyen","sequence":"additional","affiliation":[{"name":"Center for Health System Sciences, Atrium Health, Charlotte, North Carolina"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Crystal D.","family":"Connor","sequence":"additional","affiliation":[{"name":"Center for Health System Sciences, Atrium Health, Charlotte, North Carolina"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marc","family":"Kowalkowski","sequence":"additional","affiliation":[{"name":"Center for Health System Sciences, Atrium Health, Charlotte, North Carolina"},{"name":"Department of Internal Medicine, Section on Hospital Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"10","reference":[{"issue":"8","key":"ioi250048r1","doi-asserted-by":"publisher","first-page":"801","DOI":"10.1001\/jama.2016.0287","article-title":"The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3).","volume":"315","author":"Singer","year":"2016","journal-title":"JAMA"},{"issue":"13","key":"ioi250048r2","doi-asserted-by":"publisher","first-page":"1308","DOI":"10.1001\/jama.2014.2637","article-title":"Mortality related to severe sepsis and septic shock among critically ill patients in Australia and New Zealand, 2000-2012.","volume":"311","author":"Kaukonen","year":"2014","journal-title":"JAMA"},{"issue":"11","key":"ioi250048r3","doi-asserted-by":"publisher","first-page":"1181","DOI":"10.1007\/s00134-021-06506-y","article-title":"Surviving sepsis campaign: International Guidelines for Management of Sepsis and Septic Shock 2021.","volume":"47","author":"Evans","year":"2021","journal-title":"Intensive Care Med"},{"issue":"3","key":"ioi250048r4","doi-asserted-by":"publisher","first-page":"625","DOI":"10.1097\/CCM.0000000000000026","article-title":"Two decades of mortality trends among patients with severe sepsis: a comparative meta-analysis.","volume":"42","author":"Stevenson","year":"2014","journal-title":"Crit Care Med"},{"issue":"16","key":"ioi250048r5","doi-asserted-by":"publisher","first-page":"1787","DOI":"10.1001\/jama.2010.1553","article-title":"Long-term cognitive impairment and functional disability among survivors of severe sepsis.","volume":"304","author":"Iwashyna","year":"2010","journal-title":"JAMA"},{"issue":"6","key":"ioi250048r6","doi-asserted-by":"publisher","first-page":"843","DOI":"10.1097\/CCM.0000000000003023","article-title":"The impact of acute organ dysfunction on long-term survival in sepsis.","volume":"46","author":"Schuler","year":"2018","journal-title":"Crit Care Med"},{"issue":"8","key":"ioi250048r7","doi-asserted-by":"publisher","first-page":"1433","DOI":"10.1007\/s00134-015-3914-y","article-title":"Physical activity, muscle strength, and exercise capacity 3 months after severe sepsis and septic shock.","volume":"41","author":"Borges","year":"2015","journal-title":"Intensive Care Med"},{"issue":"1","key":"ioi250048r8","doi-asserted-by":"publisher","first-page":"61","DOI":"10.1016\/S2213-2600(14)70246-2","article-title":"Cognitive decline after sepsis.","volume":"3","author":"Annane","year":"2015","journal-title":"Lancet Respir Med"},{"issue":"10","key":"ioi250048r9","doi-asserted-by":"publisher","first-page":"1055","DOI":"10.1001\/jama.2015.1410","article-title":"Readmission diagnoses after hospitalization for severe sepsis and other acute medical conditions.","volume":"313","author":"Prescott","year":"2015","journal-title":"JAMA"},{"issue":"2","key":"ioi250048r10","doi-asserted-by":"publisher","first-page":"R70","DOI":"10.1186\/cc12616","article-title":"Mortality and quality of life in the five years after severe sepsis.","volume":"17","author":"Cuthbertson","year":"2013","journal-title":"Crit Care"},{"issue":"5","key":"ioi250048r12","doi-asserted-by":"publisher","first-page":"530","DOI":"10.1001\/jama.2016.20468","article-title":"Proportion and cost of unplanned 30-day readmissions after sepsis compared with other medical conditions.","volume":"317","author":"Mayr","year":"2017","journal-title":"JAMA"},{"issue":"1","key":"ioi250048r13","doi-asserted-by":"publisher","first-page":"62","DOI":"10.1001\/jama.2017.17687","article-title":"Enhancing recovery from sepsis: a review.","volume":"319","author":"Prescott","year":"2018","journal-title":"JAMA"},{"issue":"3","key":"ioi250048r14","doi-asserted-by":"publisher","first-page":"469","DOI":"10.1097\/CCM.0000000000005300","article-title":"Effect of a multicomponent sepsis transition and recovery program on mortality and readmissions after sepsis: the Improving Morbidity During Post-Acute Care Transitions for Sepsis randomized clinical trial.","volume":"50","author":"Taylor","year":"2022","journal-title":"Crit Care Med"},{"issue":"6","key":"ioi250048r15","doi-asserted-by":"publisher","first-page":"783","DOI":"10.1164\/rccm.202203-0590LE","article-title":"Effect of a transitional care intervention on rehospitalization and mortality after sepsis: a 12-month follow-up of a randomized clinical trial.","volume":"206","author":"Kowalkowski","year":"2022","journal-title":"Am J Respir Crit Care Med"},{"issue":"1","key":"ioi250048r16","doi-asserted-by":"publisher","first-page":"544","DOI":"10.1186\/s12913-021-06521-1","article-title":"Protocol for a two-arm pragmatic stepped-wedge hybrid effectiveness-implementation trial evaluating Engagement and Collaborative Management to Proactively Advance Sepsis Survivorship (ENCOMPASS).","volume":"21","author":"Kowalkowski","year":"2021","journal-title":"BMC Health Serv Res"},{"issue":"6","key":"ioi250048r17","doi-asserted-by":"publisher","first-page":"938","DOI":"10.1513\/AnnalsATS.202006-649IP","article-title":"Translating postsepsis care to post-COVID-19 care. the case for a virtual recovery program.","volume":"18","author":"Taylor","year":"2021","journal-title":"Ann Am Thorac Soc"},{"issue":"1","key":"ioi250048r18","doi-asserted-by":"publisher","first-page":"75","DOI":"10.1377\/hlthaff.28.1.75","article-title":"Evidence on the Chronic Care Model in the new millennium.","volume":"28","author":"Coleman","year":"2009","journal-title":"Health Aff (Millwood)"},{"issue":"1","key":"ioi250048r19","doi-asserted-by":"publisher","first-page":"43","DOI":"10.1097\/00001648-199001000-00010","article-title":"No adjustments are needed for multiple comparisons.","volume":"1","author":"Rothman","year":"1990","journal-title":"Epidemiology"},{"issue":"8","key":"ioi250048r21","doi-asserted-by":"publisher","first-page":"972","DOI":"10.1164\/rccm.201812-2383CP","article-title":"Understanding and enhancing sepsis survivorship. priorities for research and practice.","volume":"200","author":"Prescott","year":"2019","journal-title":"Am J Respir Crit Care Med"},{"issue":"24","key":"ioi250048r22","doi-asserted-by":"publisher","first-page":"2703","DOI":"10.1001\/jama.2016.7207","article-title":"Effect of a primary care management intervention on mental health-related quality of life among survivors of sepsis: a randomized clinical trial.","volume":"315","author":"Schmidt","year":"2016","journal-title":"JAMA"},{"issue":"5","key":"ioi250048r23","doi-asserted-by":"publisher","first-page":"665","DOI":"10.1007\/s00134-024-07359-x","article-title":"A randomized clinical trial to evaluate the effect of post-intensive care multidisciplinary consultations on mortality and the quality of life at 1 year.","volume":"50","author":"Sharshar","year":"2024","journal-title":"Intensive Care Med"},{"issue":"1","key":"ioi250048r24","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2023.53158","article-title":"Mobile critical care recovery program for survivors of acute respiratory failure: a randomized clinical trial.","volume":"7","author":"Khan","year":"2024","journal-title":"JAMA Netw Open"},{"issue":"11","key":"ioi250048r25","doi-asserted-by":"publisher","first-page":"1733","DOI":"10.1007\/s00134-016-4522-1","article-title":"A recovery program to improve quality of life, sense of coherence and psychological health in ICU survivors: a multicenter randomized controlled trial, the RAPIT study.","volume":"42","author":"Jensen","year":"2016","journal-title":"Intensive Care Med"},{"key":"ioi250048r26","doi-asserted-by":"publisher","first-page":"b3723","DOI":"10.1136\/bmj.b3723","article-title":"The PRaCTICaL study of nurse led, intensive care follow-up programmes for improving long term outcomes from critical illness: a pragmatic randomised controlled trial.","volume":"339","author":"Cuthbertson","year":"2009","journal-title":"BMJ"},{"issue":"8","key":"ioi250048r27","doi-asserted-by":"publisher","first-page":"520","DOI":"10.7326\/0003-4819-155-8-201110180-00008","article-title":"Interventions to reduce 30-day rehospitalization: a systematic review.","volume":"155","author":"Hansen","year":"2011","journal-title":"Ann Intern Med"},{"issue":"1","key":"ioi250048r28","doi-asserted-by":"publisher","first-page":"996","DOI":"10.1186\/s12913-024-11344-x","article-title":"Pre-implementation planning for a sepsis intervention in a large learning health system: a qualitative study.","volume":"24","author":"Eaton","year":"2024","journal-title":"BMC Health Serv Res"},{"key":"ioi250048r29","doi-asserted-by":"publisher","first-page":"i2375","DOI":"10.1136\/bmj.i2375","article-title":"Late mortality after sepsis: propensity matched cohort study.","volume":"353","author":"Prescott","year":"2016","journal-title":"BMJ"},{"issue":"5","key":"ioi250048r30","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2019.4900","article-title":"Risk factors at index hospitalization associated with longer-term mortality in adult sepsis survivors.","volume":"2","author":"Shankar-Hari","year":"2019","journal-title":"JAMA Netw Open"},{"issue":"2","key":"ioi250048r31","doi-asserted-by":"publisher","first-page":"179","DOI":"10.7326\/M21-2019","article-title":"Comparative effectiveness of an automated text messaging service for monitoring COVID-19 at home.","volume":"175","author":"Delgado","year":"2022","journal-title":"Ann Intern Med"},{"issue":"14","key":"ioi250048r32","doi-asserted-by":"publisher","first-page":"1371","DOI":"10.1001\/jama.2019.11982","article-title":"Effect of a hospital-initiated program combining transitional care and long-term self-management support on outcomes of patients hospitalized with chronic obstructive pulmonary disease: a randomized clinical trial.","volume":"322","author":"Aboumatar","year":"2019","journal-title":"JAMA"},{"issue":"1","key":"ioi250048r33","doi-asserted-by":"publisher","first-page":"15","DOI":"10.1097\/01.CCM.0000194535.82812.BA","article-title":"The effect of age on the development and outcome of adult sepsis.","volume":"34","author":"Martin","year":"2006","journal-title":"Crit Care Med"},{"issue":"2","key":"ioi250048r34","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2018.7571","article-title":"Prevalence, underlying causes, and preventability of sepsis-associated mortality in US acute care hospitals.","volume":"2","author":"Rhee","year":"2019","journal-title":"JAMA Netw Open"},{"issue":"4","key":"ioi250048r35","doi-asserted-by":"publisher","first-page":"627","DOI":"10.1513\/AnnalsATS.202311-998OC","article-title":"Characterizing program delivery for an effective multicomponent sepsis recovery intervention.","volume":"21","author":"Taylor","year":"2024","journal-title":"Ann Am Thorac Soc"},{"issue":"1","key":"ioi250048r36","doi-asserted-by":"publisher","first-page":"11","DOI":"10.1001\/jama.2024.6771","article-title":"Failure to rescue as a quality measure in sepsis.","volume":"332","author":"Taylor","year":"2024","journal-title":"JAMA"},{"key":"ioi250048r11","unstructured":"Weiss? AJ, Jiang? HJ. Overview of clinical conditions with frequent and costly hospital readmissions by payer, 2018. In: Healthcare Cost and Utilization Project (HCUP) Statistical Briefs. Agency for Healthcare Research and Quality; 2006. Accessed March 4, 2025. https:\/\/www.ncbi.nlm.nih.gov\/books\/NBK573265\/"},{"key":"ioi250048r20","unstructured":"World Health Organization. Global Report on the Epidemiology and Burden of Sepsis. Accessed March 4, 2025. https:\/\/www.who.int\/publications\/i\/item\/9789240010789"}],"container-title":["JAMA Internal Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/jamanetwork.com\/journals\/jamainternalmedicine\/articlepdf\/2837200\/jamainternal_taylor_2025_oi_250048_1759395960.78133.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,6]],"date-time":"2025-10-06T15:02:49Z","timestamp":1759762969000},"score":1,"resource":{"primary":{"URL":"https:\/\/jamanetwork.com\/journals\/jamainternalmedicine\/fullarticle\/2837200"}},"subtitle":["A Randomized Clinical Trial"],"short-title":[],"issued":{"date-parts":[[2025,10,1]]},"references-count":36,"journal-issue":{"issue":"10","published-print":{"date-parts":[[2025,10,1]]}},"URL":"https:\/\/doi.org\/10.1001\/jamainternmed.2025.3699","relation":{},"ISSN":["2168-6106"],"issn-type":[{"value":"2168-6106","type":"print"}],"subject":[],"published":{"date-parts":[[2025,10,1]]}}}