Findings<\/strong> In this stepped-wedge cluster randomized clinical trial including 3548 patients, 48.2% randomized to the STAR group compared with 48.0% of patients in the usual care group experienced death or rehospitalization within 90 days of discharge, without a significant difference between groups.<\/p>\n\n\n\n Meaning<\/strong> Among patients with sepsis, a specialized STAR program delivered for 90 days after discharge did not improve the composite of 90-day all-cause readmission and death.<\/a><\/p>\n\n\n\n Abstract<\/p>\n\n\n\n <\/a><\/a>Importance<\/strong> Sepsis survivors experience high morbidity and mortality after discharge, but health systems lack effective approaches to improve recovery.<\/p>\n\n\n\n Objective<\/strong> To evaluate the effect of a sepsis transition and recovery (STAR) program compared with usual care on postdischarge outcomes.<\/p>\n\n\n\n Design, Setting, and Participants<\/strong> 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.<\/p>\n\n\n\n Interventions<\/strong> 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.<\/p>\n\n\n\n Main Outcomes and Measures<\/strong> The primary outcome was the composite of all-cause hospital readmission or mortality within 90\u2009days of discharge.<\/p>\n\n\n\n Results<\/strong>\u00a0\u00a0Of 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;\u00a0P<\/em>\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;\u00a0P<\/em>\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;\u00a0P<\/em>\u2009=\u2009.24).<\/p>\n\n\n\n Conclusions and Relevance<\/strong> 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.<\/p>\n\n\n\n![\"\"\/](\"https:\/\/jamanetwork.com\/downloadimage.aspx?image=https:\/\/cdn.jamanetwork.com\/ama\/content_public\/journal\/intemed\/0\/ioi250048va_1753717145.0492.png?Expires=1758038178&Signature=P95aMSrYeqX73SLQJ8XAZGb9I0KRmyYm0zJUnoAkAA6x9527Z58jOvoWYTXoJMqAs9Nr06V52v64Oj09dMkZ9rEsw5fuYcWqelbNt4k350MFrDLwoo40bwSrdYMESMcYKG7xMokrFeFDSIT-8dPXCWKatiPW6V1GIHC-aogPpg5sX-j1-EOLFN6IAiRaOblrP-QAEMoKtYQ~i2-f6Jj0kLy0HQBTSiHJfyIXxfnX574KRTcY~SWqPDn64wIVZDljKa1lXgOCZrjOKM9RmR3A2Q3VJp7r0PSvBEe~5ew8BsE5r-tomFA52EoaYmvN4Ty6SCd8ivans5JfDgvqnAkAAQ__&Key-Pair-Id=APKAIE5G5CRDK6RD3PGA&sec=250479273&ar=2837200&imagename=&siteId=15\")
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