Clinical question: Does a telehealth-based sepsis transition and recovery (STAR) program improve 90-day mortality or hospital readmission among high-risk sepsis survivors?
Background: Sepsis survivors face substantial long-term morbidity, mortality, and readmission risk after discharge, yet scalable post-discharge interventions remain limited.
Study design: Stepped-wedge, cluster-randomized, clinical trial
Setting: Seven U.S. hospitals within a single healthcare system from July 2020 to June 2023
Synopsis: Of 19,151 hospitalized adults screened for eligibility, 3,548 patients with sepsis at high risk for readmission were enrolled in the ENCOMPASS (Engagement and Collaborative Management to Proactively Advance Sepsis Survivorship) trial and assigned to usual care (n = 1,426) or a navigator-led, telehealth-based STAR program (n = 2,122) providing post-discharge support for 90 days. The primary composite outcome combined 90-day all-cause mortality and hospital readmission, which were also analyzed separately as secondary outcomes. The composite outcome was similar between groups (48.2% versus 48.0%; adjusted odds ratio [OR], 1.05; 95% confidence interval [CI], 0.90-1.24; P = 0.53), although STAR participants had lower mortality (17.3% versus 20.5%; adjusted OR, 0.88; 95% CI, 0.77-0.99; P = 0.04) and numerically higher readmission rates (35.9% versus 33.5%; adjusted OR, 1.13; 95% CI, 0.92-1.38; P = 0.24). No differences were observed in hospital-free days, emergency department visits, or outpatient visits. Limitations include pandemic-era confounding, lack of patient-reported outcomes, complex intervention design, and early withdrawal of one site.
Bottom line: A multicomponent, navigator-led telehealth-based post-sepsis recovery program did not improve the composite 90-day outcome of mortality or readmission, despite being associated with lower mortality and numerically higher readmission rates when these outcomes were analyzed individually.
Citation: Taylor SP, et al. Proactive telehealth-based sepsis transition and recovery support, hospital readmission, and mortality: a randomized clinical trial. JAMA Intern Med. 2025;185(10):1238–1246. doi:10.1001/jamainternmed.2025.3699.
Dr. Raff
Dr. Raff is a hospitalist and professor of internal medicine at the University of North Carolina in Chapel Hill, N.C.