AHRQ Study Finds Link Between Hospital Characteristics and Sepsis Death Rates

Higher inpatient death rates from sepsis seen among blacks and Hispanics may be associated with hospital characteristics, according to new AHRQ research. A study published in Critical Care Medicineestimated sepsis mortality rates between 2004 and 2013 using data from AHRQ’s Healthcare Cost and Utilization Project. It found that after adjusting for hospital characteristics, sepsis mortality rates (which are falling overall) were similar in 2013 for white, black and Hispanic patients. However, sepsis mortality rates remained elevated for Asian/Pacific Islanders and patients classified as belonging to “other” racial/ethnic groups. Hospital characteristics that affected mortality included status as teaching, critical access or safety-net hospitals; urban or rural location; ownership status; and size. Access the abstract.

2017 Sep 12. doi: 10.1097/CCM.0000000000002699. [Epub ahead of print]

Racial Disparities in Sepsis-Related In-Hospital Mortality: Using a Broad Case Capture Method and Multivariate Controls for Clinical and Hospital Variables, 2004-2013.

Jones JM1, Fingar KR, Miller MA, Coffey R, Barrett M, Flottemesch T, Heslin KC, Gray DT, Moy E.

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Abstract

OBJECTIVES:

As sepsis hospitalizations have increased, in-hospital sepsis deaths have declined. However, reported rates may remain higher among racial/ethnic minorities. Most previous studies have adjusted primarily for age and sex. The effect of other patient and hospital characteristics on disparities in sepsis mortality is not yet well-known. Furthermore, coding practices in claims data may influence findings. The objective of this study was to use a broad method of capturing sepsis cases to estimate 2004-2013 trends in risk-adjusted in-hospital sepsis mortality rates by race/ethnicity to inform efforts to reduce disparities in sepsis deaths.

DESIGN:

Retrospective, repeated cross-sectional study.

SETTING:

Acute care hospitals in the Healthcare Cost and Utilization Project State Inpatient Databases for 18 states with consistent race/ethnicity reporting.

PATIENTS:

Patients diagnosed with septicemia, sepsis, organ dysfunction plus infection, severe sepsis, or septic shock.

MEASUREMENTS AND MAIN RESULTS:

In-hospital sepsis mortality rates adjusted for patient and hospital factors by race/ethnicity were calculated. From 2004 to 2013, sepsis hospitalizations for all racial/ethnic groups increased, and mortality rates decreased by 5-7% annually. Mortality rates adjusted for patient characteristics were higher for all minority groups than for white patients. After adjusting for hospital characteristics, sepsis mortality rates in 2013 were similar for white (92.0 per 1,000 sepsis hospitalizations), black (94.0), and Hispanic (93.5) patients but remained elevated for Asian/Pacific Islander (106.4) and "other" (104.7; p < 0.001) racial/ethnic patients.

CONCLUSIONS:

Our results indicate that hospital characteristics contribute to higher rates of sepsis mortality for blacks and Hispanics. These findings underscore the importance of ensuring that improved sepsis identification and management is implemented across all hospitals, especially those serving diverse populations.