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Assessing Variability in Hospital-Level Mortality Among U.S. Medicare Beneficiaries With Hospitalizations for Severe Sepsis and Septic Shock.
Crit Care Med. 2018 11; 46(11):1753-1760.CC

Abstract

OBJECTIVES

To assess the variability in short-term sepsis mortality by hospital among Centers for Medicare and Medicaid Services beneficiaries in the United States during 2013-2014.

DESIGN

A retrospective cohort design.

SETTING

Hospitalizations from 3,068 acute care hospitals that participated in the Centers for Medicare and Medicaid Services inpatient prospective payment system in 2013 and 2014.

PATIENTS

Medicare fee-for-service beneficiaries greater than or equal to 65 years old who had an inpatient hospitalization coded with present at admission severe sepsis or septic shock.

INTERVENTIONS

None.

MEASUREMENTS AND MAIN RESULTS

Individual level mortality was assessed as death at or within 7 days of hospital discharge and aggregated to calculate hospital-level mortality rates. We used a logistic hierarchal linear model to calculate mortality risk-adjusted for patient characteristics. We quantified variability among hospitals using the median odds ratio and calculated risk-standardized mortality rates for each hospital. The overall crude mortality rate was 34.7%. We found significant variability in mortality by hospital (p < 0.001). The middle 50% of hospitals had similar risk-standardized mortality rates (32.7-36.9%), whereas the decile of hospitals with the highest risk-standardized mortality rates had a median mortality rate of 40.7%, compared with a median of 29.2% for hospitals in the decile with the lowest risk-standardized mortality rates. The median odds ratio (1.29) was lower than the adjusted odds ratios for several measures of patient comorbidities and severity of illness, including present at admission organ dysfunction, no identified source of infection, and age.

CONCLUSIONS

In a large study of present at admission sepsis among Medicare beneficiaries, we showed that mortality was most strongly associated with underlying comorbidities and measures of illness on arrival. However, after adjusting for patient characteristics, mortality also modestly depended on where a patient with sepsis received care, suggesting that efforts to improve sepsis outcomes in lower performing hospitals could impact sepsis survival.

Authors+Show Affiliations

Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, GA.Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, GA. Division of Hospital Medicine, Emory University School of Medicine, Atlanta, GA.Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, GA.Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, GA.Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, GA.Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, GA.Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, GA.

Pub Type(s)

Journal Article
Research Support, U.S. Gov't, P.H.S.

Language

eng

PubMed ID

30024430

Citation

Hatfield, Kelly M., et al. "Assessing Variability in Hospital-Level Mortality Among U.S. Medicare Beneficiaries With Hospitalizations for Severe Sepsis and Septic Shock." Critical Care Medicine, vol. 46, no. 11, 2018, pp. 1753-1760.
Hatfield KM, Dantes RB, Baggs J, et al. Assessing Variability in Hospital-Level Mortality Among U.S. Medicare Beneficiaries With Hospitalizations for Severe Sepsis and Septic Shock. Crit Care Med. 2018;46(11):1753-1760.
Hatfield, K. M., Dantes, R. B., Baggs, J., Sapiano, M. R. P., Fiore, A. E., Jernigan, J. A., & Epstein, L. (2018). Assessing Variability in Hospital-Level Mortality Among U.S. Medicare Beneficiaries With Hospitalizations for Severe Sepsis and Septic Shock. Critical Care Medicine, 46(11), 1753-1760. https://doi.org/10.1097/CCM.0000000000003324
Hatfield KM, et al. Assessing Variability in Hospital-Level Mortality Among U.S. Medicare Beneficiaries With Hospitalizations for Severe Sepsis and Septic Shock. Crit Care Med. 2018;46(11):1753-1760. PubMed PMID: 30024430.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Assessing Variability in Hospital-Level Mortality Among U.S. Medicare Beneficiaries With Hospitalizations for Severe Sepsis and Septic Shock. AU - Hatfield,Kelly M, AU - Dantes,Raymund B, AU - Baggs,James, AU - Sapiano,Mathew R P, AU - Fiore,Anthony E, AU - Jernigan,John A, AU - Epstein,Lauren, PY - 2018/7/20/pubmed PY - 2019/9/24/medline PY - 2018/7/20/entrez SP - 1753 EP - 1760 JF - Critical care medicine JO - Crit Care Med VL - 46 IS - 11 N2 - OBJECTIVES: To assess the variability in short-term sepsis mortality by hospital among Centers for Medicare and Medicaid Services beneficiaries in the United States during 2013-2014. DESIGN: A retrospective cohort design. SETTING: Hospitalizations from 3,068 acute care hospitals that participated in the Centers for Medicare and Medicaid Services inpatient prospective payment system in 2013 and 2014. PATIENTS: Medicare fee-for-service beneficiaries greater than or equal to 65 years old who had an inpatient hospitalization coded with present at admission severe sepsis or septic shock. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Individual level mortality was assessed as death at or within 7 days of hospital discharge and aggregated to calculate hospital-level mortality rates. We used a logistic hierarchal linear model to calculate mortality risk-adjusted for patient characteristics. We quantified variability among hospitals using the median odds ratio and calculated risk-standardized mortality rates for each hospital. The overall crude mortality rate was 34.7%. We found significant variability in mortality by hospital (p < 0.001). The middle 50% of hospitals had similar risk-standardized mortality rates (32.7-36.9%), whereas the decile of hospitals with the highest risk-standardized mortality rates had a median mortality rate of 40.7%, compared with a median of 29.2% for hospitals in the decile with the lowest risk-standardized mortality rates. The median odds ratio (1.29) was lower than the adjusted odds ratios for several measures of patient comorbidities and severity of illness, including present at admission organ dysfunction, no identified source of infection, and age. CONCLUSIONS: In a large study of present at admission sepsis among Medicare beneficiaries, we showed that mortality was most strongly associated with underlying comorbidities and measures of illness on arrival. However, after adjusting for patient characteristics, mortality also modestly depended on where a patient with sepsis received care, suggesting that efforts to improve sepsis outcomes in lower performing hospitals could impact sepsis survival. SN - 1530-0293 UR - https://www.unboundmedicine.com/medline/citation/30024430/Assessing_Variability_in_Hospital_Level_Mortality_Among_U_S__Medicare_Beneficiaries_With_Hospitalizations_for_Severe_Sepsis_and_Septic_Shock_ L2 - https://dx.doi.org/10.1097/CCM.0000000000003324 DB - PRIME DP - Unbound Medicine ER -