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Hospital Variation in Risk-Adjusted Pediatric Sepsis Mortality.
Pediatr Crit Care Med. 2018 05; 19(5):390-396.PC

Abstract

OBJECTIVES

With continued attention to pediatric sepsis at both the clinical and policy levels, it is important to understand the quality of hospitals in terms of their pediatric sepsis mortality. We sought to develop a method to evaluate hospital pediatric sepsis performance using 30-day risk-adjusted mortality and to assess hospital variation in risk-adjusted sepsis mortality in a large state-wide sample.

DESIGN

Retrospective cohort study using administrative claims data.

SETTINGS

Acute care hospitals in the state of Pennsylvania from 2011 to 2013.

PATIENTS

Patients between the ages of 0-19 years admitted to a hospital with sepsis defined using validated International Classification of Diseases, Ninth revision, Clinical Modification, diagnosis and procedure codes.

INTERVENTIONS

None.

MEASUREMENTS AND MAIN RESULTS

During the study period, there were 9,013 pediatric sepsis encounters in 153 hospitals. After excluding repeat visits and hospitals with annual patient volumes too small to reliably assess hospital performance, there were 6,468 unique encounters in 24 hospitals. The overall unadjusted mortality rate was 6.5% (range across all hospitals: 1.5-11.9%). The median number of pediatric sepsis cases per hospital was 67 (range across all hospitals: 30-1,858). A hierarchical logistic regression model for 30-day risk-adjusted mortality controlling for patient age, gender, emergency department admission, infection source, presence of organ dysfunction at admission, and presence of chronic complex conditions showed good discrimination (C-statistic = 0.80) and calibration (slope and intercept of calibration plot: 0.95 and -0.01, respectively). The hospital-specific risk-adjusted mortality rates calculated from this model varied minimally, ranging from 6.0% to 7.4%.

CONCLUSIONS

Although a risk-adjustment model for 30-day pediatric sepsis mortality had good performance characteristics, the use of risk-adjusted mortality rates as a hospital quality measure in pediatric sepsis is not useful due to the low volume of cases at most hospitals. Novel metrics to evaluate the quality of pediatric sepsis care are needed.

Authors+Show Affiliations

CRISMA Center, Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA.CRISMA Center, Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA.CRISMA Center, Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA. Department of Health Policy & Management, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA.CRISMA Center, Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA. Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, PA.CRISMA Center, Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA. Department of Health Policy & Management, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA.

Pub Type(s)

Journal Article
Research Support, N.I.H., Extramural

Language

eng

PubMed ID

29461429

Citation

Ames, Stefanie G., et al. "Hospital Variation in Risk-Adjusted Pediatric Sepsis Mortality." Pediatric Critical Care Medicine : a Journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies, vol. 19, no. 5, 2018, pp. 390-396.
Ames SG, Davis BS, Angus DC, et al. Hospital Variation in Risk-Adjusted Pediatric Sepsis Mortality. Pediatr Crit Care Med. 2018;19(5):390-396.
Ames, S. G., Davis, B. S., Angus, D. C., Carcillo, J. A., & Kahn, J. M. (2018). Hospital Variation in Risk-Adjusted Pediatric Sepsis Mortality. Pediatric Critical Care Medicine : a Journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies, 19(5), 390-396. https://doi.org/10.1097/PCC.0000000000001502
Ames SG, et al. Hospital Variation in Risk-Adjusted Pediatric Sepsis Mortality. Pediatr Crit Care Med. 2018;19(5):390-396. PubMed PMID: 29461429.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Hospital Variation in Risk-Adjusted Pediatric Sepsis Mortality. AU - Ames,Stefanie G, AU - Davis,Billie S, AU - Angus,Derek C, AU - Carcillo,Joseph A, AU - Kahn,Jeremy M, PY - 2018/2/21/pubmed PY - 2019/5/16/medline PY - 2018/2/21/entrez SP - 390 EP - 396 JF - Pediatric critical care medicine : a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies JO - Pediatr Crit Care Med VL - 19 IS - 5 N2 - OBJECTIVES: With continued attention to pediatric sepsis at both the clinical and policy levels, it is important to understand the quality of hospitals in terms of their pediatric sepsis mortality. We sought to develop a method to evaluate hospital pediatric sepsis performance using 30-day risk-adjusted mortality and to assess hospital variation in risk-adjusted sepsis mortality in a large state-wide sample. DESIGN: Retrospective cohort study using administrative claims data. SETTINGS: Acute care hospitals in the state of Pennsylvania from 2011 to 2013. PATIENTS: Patients between the ages of 0-19 years admitted to a hospital with sepsis defined using validated International Classification of Diseases, Ninth revision, Clinical Modification, diagnosis and procedure codes. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: During the study period, there were 9,013 pediatric sepsis encounters in 153 hospitals. After excluding repeat visits and hospitals with annual patient volumes too small to reliably assess hospital performance, there were 6,468 unique encounters in 24 hospitals. The overall unadjusted mortality rate was 6.5% (range across all hospitals: 1.5-11.9%). The median number of pediatric sepsis cases per hospital was 67 (range across all hospitals: 30-1,858). A hierarchical logistic regression model for 30-day risk-adjusted mortality controlling for patient age, gender, emergency department admission, infection source, presence of organ dysfunction at admission, and presence of chronic complex conditions showed good discrimination (C-statistic = 0.80) and calibration (slope and intercept of calibration plot: 0.95 and -0.01, respectively). The hospital-specific risk-adjusted mortality rates calculated from this model varied minimally, ranging from 6.0% to 7.4%. CONCLUSIONS: Although a risk-adjustment model for 30-day pediatric sepsis mortality had good performance characteristics, the use of risk-adjusted mortality rates as a hospital quality measure in pediatric sepsis is not useful due to the low volume of cases at most hospitals. Novel metrics to evaluate the quality of pediatric sepsis care are needed. SN - 1529-7535 UR - https://www.unboundmedicine.com/medline/citation/29461429/Hospital_Variation_in_Risk_Adjusted_Pediatric_Sepsis_Mortality_ L2 - https://doi.org/10.1097/PCC.0000000000001502 DB - PRIME DP - Unbound Medicine ER -