Impact of the Japanese clinical practice guidelines for management of sepsis and septic shock (J-SSCG) 2020 on real-world adherence and interhospital variation: a nationwide inpatient database study
Authors' conclusion
This nationwide study identified persistent evidence-practice gaps, minimal improvements in adherence after J-SSCG 2020, and substantial interhospital variation that remained unaltered.
Study context
- Population
- Patients with sepsis in the Japanese Diagnosis Procedure Combination database, April 2018–December 2021
- Participants
- 213,099 patients · 791 hospitals
- Exposure
- Adherence before vs after J-SSCG 2020 publication
- Outcome
- Adherence to 26 evaluable J-SSCG 2020 recommendations and between-hospital variation (intraclass correlation coefficients)
Methodological detailsnationwide, interrupted time series analysis, inpatient database
- Nationwide
- Interrupted time series analysis
- Inpatient database
Main finding
As reported in the abstract
Adherence rates across clinical questions (CQs) (range)
0.5-98.7%
Increase in adherence after publication for most CQs
< 3% points
No abrupt or substantial changes on interrupted time series analysis; significant trends modest (annually)
< 2%
CQs with adjusted intraclass correlation coefficients >10% (persistent between-hospital variation, unchanged after release)
22
Observational data: associations, not effects.
Further findings
CQs consistent with J-SSCG 2016 vs newly introduced in 2020 (subgroup)
- CQs consistent with J-SSCG 2016
- 14
- CQs newly introduced in 2020
- 12
- Both showed similarly limited changes in adherence
Original publication
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