Key result
Top hospital quality scores linked to ~16% higher 30-day readmissions among Medicare sepsis survivors.
Cross-Sectional (n=633,407)
Yes
Absolute Event Rate: 32% vs 27.5%
p-value: p=<0.001
Nearly one-third of Medicare sepsis survivors are readmitted within 30 days, with higher readmission rates paradoxically observed in hospitals with higher quality measures and lower mortality.
Sepsis readmissions vary widely by hospital factors and correlate inversely with quality metrics; leaves open whether readmission rates validly reflect care quality.
OBJECTIVES: To determine national readmission rates among sepsis survivors, variations in rates between hospitals, and determine whether measures of quality correlate with performance on sepsis readmissions. DESIGN: Cross-sectional study of sepsis readmissions between 2008 and 2011 in the Medicare fee-for-service database. SETTING: Acute care, Medicare participating hospitals from 2008 to 2011. PATIENTS: Septic patients as identified by International Classification of Diseases, Ninth Revision codes using the Angus method. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: We generated hospital-level, risk-standardized, 30-day readmission rates among survivors of sepsis and compared rates across region, ownership, teaching status, sepsis volume, hospital size, and proportion of underserved patients. We examined the relationship between risk-standardized readmission rates and hospital-level composite measures of quality and mortality. From 633,407 hospitalizations among 3,315 hospitals from 2008 to 2011, median risk-standardized readmission rates was 28.7% (interquartile range, 26.1-31.9). There were differences in risk-standardized readmission rates by region (Northeast, 30.4%; South, 29.6%; Midwest, 28.8%; and West, 27.7%; p < 0.001), teaching versus nonteaching status (31.1% vs 29.0%; p < 0.001), and hospitals serving the highest proportion of underserved patients (30.6% vs 28.7%; p < 0.001). The best performing hospitals on a composite quality measure had highest risk-standardized readmission rates compared with the lowest (32.0% vs 27.5%; p < 0.001). Risk-standardized readmission rates was lower in the highest mortality hospitals compared with those in the lowest (28.7% vs 30.7%; p < 0.001). CONCLUSIONS: One third of sepsis survivors were readmitted and wide variation exists between hospitals. Several demographic and structural factors are associated with this variation. Measures of higher quality in-hospital care were correlated with higher readmission rates. Several potential explanations are possible including poor risk standardization, more research is needed.
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Norman et al. (2017) conducted a cross-sectional in Sepsis (n=633,407). High hospital composite quality measure vs. Low hospital composite quality measure was evaluated on 30-day risk-standardized readmission rate (p=<0.001). Among Medicare sepsis survivors, the median 30-day risk-standardized readmission rate was 28.7%, with higher rates in hospitals with the best composite quality measures (32.0% vs 27.5%; P<0.001).
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