Increased 1-Year Healthcare Use in Survivors of Severe Sepsis
Hallie C. Prescott1, Kenneth M. Langa1,2,3, Vincent Liu4, Gabriel J. Escobar4, and Theodore J. Iwashyna1,2,3
1Department of Medicine, University of Michigan, Ann Arbor, Michigan
2VA Center for Clinical Management Research, HSR&D Center for Excellence, Ann Arbor, Michigan
3Institute for Social Research, Ann Arbor, Michigan; and
4Kaiser Permanente Division of Research, Oakland, California
Corresponding Author: Hallie C. Prescott
Rationale:
Hospitalizations for severe sepsis are common, and a growing number of patients survive to hospital discharge. Nonetheless, little is known about survivors’ post-discharge healthcare use.
Objectives:
To measure inpatient healthcare use of severe sepsis survivors compared with patients’ own presepsis resource use and the resource use of survivors of otherwise similar nonsepsis hospitalizations.
Methods:
This is an observational cohort study of survivors of severe sepsis and nonsepsis hospitalizations identified from participants in the Health and Retirement Study with linked Medicare claims, 1998–2005. We matched severe sepsis and nonsepsis hospitalizations by demographics, comorbidity burden, premorbid disability, hospitalization length, and intensive care use.
Measurements and Main Results:
Using Medicare claims, we measured patients’ use of inpatient facilities (hospitals, long-term acute care hospitals, and skilled nursing facilities) in the 2 years surrounding hospitalization. Severe sepsis survivors spent more days (median, 16 [interquartile range, 3–45] vs. 7 [0–29]; P < 0.001) and a higher proportion of days alive (median, 9.6% [interquartile range, 1.4–33.8%] vs. 1.9% [0.0–7.9%]; P < 0.001) admitted to facilities in the year after hospitalization, compared with the year prior. The increase in facility-days was similar for nonsepsis hospitalizations. However, the severe sepsis cohort experienced greater post-discharge mortality (44.2% [95% confidence interval, 41.3–47.2%] vs. 31.4% [95% confidence interval, 28.6–34.2%] at 1 year), a steeper decline in days spent at home (difference-in-differences, －38.6 d [95% confidence interval, －50.9 to 26.3]; P < 0.001), and a greater increase in the proportion of days alive spent in a facility (difference-in-differences, 5.4% [95% confidence interval, 2.8–8.1%]; P < 0.001).
<font size="4">Conclusions:
Healthcare use is markedly elevated after severe sepsis, and post-discharge management may be an opportunity to reduce resource use.
Hallie C. Prescott1, Kenneth M. Langa1,2,3, Vincent Liu4, Gabriel J. Escobar4, and Theodore J. Iwashyna1,2,3
1Department of Medicine, University of Michigan, Ann Arbor, Michigan
2VA Center for Clinical Management Research, HSR&D Center for Excellence, Ann Arbor, Michigan
3Institute for Social Research, Ann Arbor, Michigan; and
4Kaiser Permanente Division of Research, Oakland, California
Corresponding Author: Hallie C. Prescott
Rationale:
Hospitalizations for severe sepsis are common, and a growing number of patients survive to hospital discharge. Nonetheless, little is known about survivors’ post-discharge healthcare use.
Objectives:
To measure inpatient healthcare use of severe sepsis survivors compared with patients’ own presepsis resource use and the resource use of survivors of otherwise similar nonsepsis hospitalizations.
Methods:
This is an observational cohort study of survivors of severe sepsis and nonsepsis hospitalizations identified from participants in the Health and Retirement Study with linked Medicare claims, 1998–2005. We matched severe sepsis and nonsepsis hospitalizations by demographics, comorbidity burden, premorbid disability, hospitalization length, and intensive care use.
Measurements and Main Results:
Using Medicare claims, we measured patients’ use of inpatient facilities (hospitals, long-term acute care hospitals, and skilled nursing facilities) in the 2 years surrounding hospitalization. Severe sepsis survivors spent more days (median, 16 [interquartile range, 3–45] vs. 7 [0–29]; P < 0.001) and a higher proportion of days alive (median, 9.6% [interquartile range, 1.4–33.8%] vs. 1.9% [0.0–7.9%]; P < 0.001) admitted to facilities in the year after hospitalization, compared with the year prior. The increase in facility-days was similar for nonsepsis hospitalizations. However, the severe sepsis cohort experienced greater post-discharge mortality (44.2% [95% confidence interval, 41.3–47.2%] vs. 31.4% [95% confidence interval, 28.6–34.2%] at 1 year), a steeper decline in days spent at home (difference-in-differences, －38.6 d [95% confidence interval, －50.9 to 26.3]; P < 0.001), and a greater increase in the proportion of days alive spent in a facility (difference-in-differences, 5.4% [95% confidence interval, 2.8–8.1%]; P < 0.001).
<font size="4">Conclusions:
Healthcare use is markedly elevated after severe sepsis, and post-discharge management may be an opportunity to reduce resource use.
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