Sepsis Patients Face Poor Healthcare Trajectories Following Hospitalization

Medicare beneficiaries hospitalized with sepsis, whether the condition was present on admission or acquired during hospitalization, are at increased risk for worsening health and death, and have greater use of advanced healthcare services and less likelihood of being discharged to home compared with non-sepsis patients, according to a report published in Critical Care Medicine.

“Once sepsis is established, improving the immediate post-sepsis trajectory…appears to be an essential step toward value-based transformation of sepsis care.”-Timothy G. Buchman, PhD, MD, U.S. Department of Health and Human Services

“The trajectories of beneficiaries subsequent to a sepsis inpatient admission contrast sharply with those admissions that do not include sepsis,” write the authors. “Despite seemingly successful treatments of infection and organ dysfunction, sepsis survivors frequently fail to fully recover their health and their prior quality of life.”

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Investigators analyzed Medicare claims data for patients admitted to all U.S. acute care hospitals with sepsis (n = 69,401) and without sepsis (n = 613,395) in January 2017. They first reviewed diagnostic, procedure and encounter codes for the year prior to admission. Next, they compared healthcare services used in the week prior to admission by all sepsis inpatients with all non-sepsis inpatients admitted from 2012 to 2017, then compared the subsequent health trajectories of the two groups. 

Findings: One Year Prior to Admission

Researchers found no discernible differences and “no particular predictive insight” about the two groups when they compared the 10 most prevalent chronic conditions among the non-sepsis patients who had been admitted to the hospital prior to January 2017 to the patients who were admitted and developed sepsis.

However, the top discriminant diagnosis for sepsis admission was “other sepsis.” Sepsis had occurred earlier (in the previous year) in about 10% of patients with a current sepsis-coded admission, a percentage that was 3.5 times higher than the rate among patients with no sepsis during the index hospitalization.

Among patients with no hospital admissions in the prior year, those whose inpatient stays included a sepsis code, compared with patients with no sepsis, had:

• More than three times as many deaths within one week of discharge 
• More admissions to skilled nursing facilities (SNFs) and fewer discharges to home

Findings: One Week Prior to Admission

• Claims for services in nursing facilities in the week prior to admission were 2.5 times higher among patients with subsequent sepsis admission, suggesting that recent use of skilled or unskilled nursing care was a strong indicator of patients being destined for sepsis admission.
• 15% of patients with septic shock had inpatient claims for sepsis in the week prior, as did 10% of those with other severities of sepsis.

Overall, the percentage of sepsis admissions increased from 2012 to 2018—particularly among patients with sepsis present on admission—while the non-sepsis admissions decreased during that time.

Further, sepsis admissions also accounted for a rising percentage of long inpatient stays, while the percentage of long stays for non-sepsis patients declined.

Six-Month Trajectories Following Index Admission

• Discharged to a personal home: 57.2% sepsis vs 79.8% non-sepsis 
• Died: 32.6% vs 13.3%
• Transferred to a nursing home: 5.0% vs 2.8% 
• Transferred to a SNF: 2.3% vs 1.7% 
• Transferred to a hospice facility: 1.8% vs 1.4% 

Among all patients admitted to a SNF subsequent to discharge, those with sepsis were more likely than those with no sepsis to:

• Die in the SNF
• Be readmitted to an acute-care hospital and die in that setting 
• Go next to a custodial nursing home if they had survived to discharge from the SNF 

“All sepsis admissions are not the same,” note the authors. Patients with septic shock are more likely to die in the hospital and less likely to reach a SNF. Only 36% return home within six months. Further, while 54% of patients with sepsis diagnosed on admission returned home within six months, only 32% of those with sepsis diagnosed while an inpatient did so.

Source: Buchman, T.G., et al. (2020). Sepsis among Medicare beneficiaries: 2. The trajectories of sepsis, 2012-2018. Critical Care Medicine, 48(3):289-301.Biomedical Advanced Research and Development Authority, Office of the Assistant Secretary for Preparedness and Response, U.S. Department of Health and Human Services, Washington, DC; Emory Critical Care Center, Emory University, Atlanta; Center for Medicare and Medicaid Services, U.S. Department of Health and Human Services, Baltimore.