Sepsis Among Medicare Beneficiaries: 2. The Trajectories of Sepsis, 2012-2018
Sepsis Among Medicare Beneficiaries: 2. The Trajectories of Sepsis, 2012-2018
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DOI：
10.1097/ccm.0000000000004226
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发表时间：
2020-03-01
影响因子：
8.8
通讯作者：
Kelman, Jeffrey A.
中科院分区：
文献类型：
--
作者：
Buchman, Timothy G.;Simpson, Steven Q.;Kelman, Jeffrey A.
目的：区分因脓毒症而急性住院的Medicare受益人与无脓毒症而住院的Medicare受益人的特征，并描述他们在住院期间和之后的进一步轨迹。设计：通过Medicare和Medicaid服务数据链接项目中心分析已支付的Medicare索赔。设置：除联邦医院外的所有美国急性护理医院（退伍军人管理局和国防卫生署）.患者：医疗保险受益人，2012-2018，与住院入院包括一个或多个明确的败血症代码.干预：无.测量和主要结果：在住院入院前一年的流行诊断;住院前一周内的医疗保健联系人;出院后6个月内的出院、转院、再入院和死亡（轨迹）。在因脓毒症入院前一年内无脓毒症住院的受益人几乎无法通过累积诊断代码与无脓毒症入院的受益人区分开来。虽然住院前一周的医疗服务时间在因败血症入院的受益人与住院不包括败血症代码的受益人之间相似，但设置不同：注定要接受败血症入院的受益人更有可能接受熟练护理或不熟练护理（例如，日常生活活动护理助手）护理。相比之下，比较受益人已经免费住院一整年，然后需要住院治疗，急性住院治疗，包括脓毒症代码导致超过三倍的死亡人数在出院后一周内，更多的人进入专业护理机构，更少的人出院回家。比较住院后进入专业护理设施的所有受益人，在索引入院期间编码为脓毒症的受益人更有可能在专业护理设施中死亡;更有可能再次进入急性住院医院，随后在该环境中死亡;或者，如果他们能从专业护理机构出院，他们更有可能去旁边的监护式养老院。虽然医疗保险受益人注定与败血症代码住院入院几乎无法区分其他诊断代码从那些入院将没有败血症代码，他们入院后的健康状况更差。这表明，包括败血症代码的住院患者不仅可以识别出对感染抵抗力较低的受益人，而且还表明健康状况恶化、死亡率以及出院期间和出院后使用先进医疗服务的风险增加沿着同时住院患者再次入院的可能性增加。
Objectives:To distinguish characteristics of Medicare beneficiaries who will have an acute inpatient admission for sepsis from those who have an inpatient admission without sepsis, and to describe their further trajectories during and subsequent to those inpatient admissions.Design:Analysis of paid Medicare claims via the Centers for Medicare and Medicaid Services DataLink Project.Setting:All U.S. acute care hospitals, excepting federal hospitals (Veterans Administration and Defense Health Agency).Patients:Medicare beneficiaries, 2012-2018, with an inpatient hospital admission including one or more explicit sepsis codes.Interventions:None.Measurements and Main Results:Prevalent diagnoses in the year prior to the inpatient admission; healthcare contacts in the week prior to the inpatient admission; discharges, transfers, readmissions, and deaths (trajectories) for 6 months following discharge from the inpatient admission. Beneficiaries with no sepsis inpatient hospital admission for a year prior to an index hospital admission for sepsis were nearly indistinguishable by accumulated diagnostic codes from beneficiaries who had an index hospital admission without sepsis. Although the timing of healthcare services in the week prior to inpatient hospital admission was similar among beneficiaries who would be admitted for sepsis versus those whose inpatient admission did not include a sepsis code, the setting differed: beneficiaries destined for a sepsis admission were more likely to have received skilled nursing or unskilled nursing (e.g., nursing aide for activities of daily living) care. In contrast, comparing beneficiaries who had been free of any inpatient admission for an entire year and then required an inpatient admission, acute inpatient stays that included a sepsis code led to more than three times as many deaths within 1 week of discharge, with more admissions to skilled nursing facilities and fewer discharges to home. Comparing all beneficiaries who were admitted to a skilled nursing facility after an inpatient hospital admission, those who had sepsis coded during the index admission were more likely to die in the skilled nursing facility; more likely to be readmitted to an acute inpatient hospital and subsequently die in that setting; or if they survive to discharge from the skilled nursing facility, they are more likely to go next to a custodial nursing home.Conclusions:Although Medicare beneficiaries destined for an inpatient hospital admission with a sepsis code are nearly indistinguishable by other diagnostic codes from those whose admissions will not have a sepsis code, their healthcare trajectories following the admission are worse. This suggests that an inpatient stay that included a sepsis code not only identifies beneficiaries who were less resilient to infection but also signals increased risk for worsening health, for mortality, and for increased use of advanced healthcare services during and postdischarge along with an increased likelihood of an inpatient hospital readmission.