Comments: Though sophisticated and diverse statistical methods were used to assess the robustness of the analysis, this study is retrospective. Unidentified confounders, clinical sepsis risk stratification (the presence of obstructive uropathy or impairments leading to aspiration or skin breakdown, for example) are not accounted for in the analysis. Nonetheless, the hypothesis is of high relevance to hospitalists; it has biologic plausibility, and the results are intriguing if not definitive.
From a practical perspective, it seems prudent to ensure ongoing statin use for all patients with appropriate traditional indications. Initiating statins for the sole purpose of reducing future risk of sepsis is not yet sufficiently supported by the available evidence, and the NNT of almost 600 patients per year in the current study does little to alter that recommendation. In reply to a subsequent letter to the editor, the authors pointed out that the high NNT in part reflects the low-risk profile of the cohort and would be lower in higher risk patients; for example, patients with chronic renal failure, previous infections, or corticosteroid use would have NNTs of 166, 250, and 250, respectively.2 A randomized, controlled prospective trial would be a welcome addition to the evidence on this important topic, as would studies of the use of statins solely as an acute intervention upon suspicion of sepsis.
References
- MRC/BHF Heart Protection Study of cholesterol lowering with simvastatin in 20,536 high-risk individuals: a randomised placebo-controlled trial. Lancet. 2002 Jul 6;360(9326):7-22.
- Hackam DG, Redelmeier DA. Statins and sepsis—authors’ reply. Lancet. 2006;367:1651.
Review: Impact of Health Information Technology
Advances in information technology have transformed the world of business and education and will undoubtedly change the delivery and implementation of medical services. What arguably sets the world of health information apart from other systems is, however, the extreme sensitivity of the data involved and the impact it has on human lives.
Methods and data sources: In the article, “Systemic Review: Impact of Health Information Technology on Quality, Efficiency, and Costs of Medical Care,” the authors reviewed four data sources and extracted information on system design, effects on quality and cost benefit analysis. Four data sources were utilized including a MEDLINE analysis of articles indexed as health information technology (HIT) from 1995 to January 2004 utilizing:
- Cochrane Center Registry of Controlled Trials;
- Cochrane Database of Abstracts of Reviews of Effects;
- Periodical Abstracts Database; and
- Studies singled out by experts up to April of 2005
Of the four data sources, 24% of all studies came from the following academic centers: the Regenstrief Institute (Indianapolis), Brigham and Women’s Hospital (Boston), Department of Veterans Affairs, and the Latter Day Saints Hospital/Intermountain Health Care.
Inclusion criteria: The HIT evaluation and efficacy information derived was from these four academic institutions, each with its own EHR (electronic health record) system. Of 4,582 initial articles derived from a title review, 867 were deemed suitable given their title matter, but only 257 met inclusion criteria.
A modified framework from the Institute of Medicine’s six aims for care and a framework to analyze costs developed by the authors themselves was used for analysis.1
Reasons for rejection: Articles that did not have HIT as the subject, others that did not report outcomes data, and those that did not examine barriers for outcomes analysis were rejected.
Information examined: Extracted information on system capabilities including components of the system such as:
- User friendliness;
- Types of systems such as EHR that allowed for medical decision making support and e-prescribing; and
- Functional capabilities such as order entry and clinical documentation.