A cohort examine involving greater than 2.5 million older sufferers with sepsis discovered that admission to safety-net hospitals was related to greater in-hospital mortality than non–safety-net hospitals, researchers reported late final week in JAMA Community Open.
The authors of the examine say the findings could also be tied to the better use of hospice at non–safety-net hospitals, which shifts attribution of loss of life from the index hospitalization to hospice care.
The examine, led by researchers at Boston College (BU) Medical College and Beth Israel Deaconess Medical Heart, examined medical document of Medicare fee-for-service beneficiaries aged 66 years and older who had been admitted with sepsis to an intensive care unit from January 2011 to December 2019. Co-primary outcomes included in-hospital mortality and 30-day mortality.
No distinction in 30-day mortality
Greater than 2.5 million sufferers with sepsis (imply age, 78.8 years; 51.9% feminine; 83.8% White) had been admitted to 666 safety-net hospitals and 1,924 non–safety-net hospitals through the examine interval. Admission to safety-net hospitals was related to greater in-hospital mortality (odds ratio [OR], 1.09; 95% confidence interval [CI], 1.06 to 1.13) however not 30-day mortality (OR, 1.01; 95% CI, 0.99 to 1.04), which the authors say is a much less biased measure of short-term mortality.
Admission to safety-net hospitals was additionally related to decrease do-not-resuscitate charges (OR, 0.86; 95% CI, 0.81 to 0.91), palliative care supply charges (OR, 0.66; 95% CI, 0.60 to 0.73), and hospice discharge (OR, 0.82; 95% CI, 0.78 to 0.87) however not with discharge to postacute amenities (OR, 0.98; 95% CI, 0.95 to 1.01).
The authors say the findings are important as a result of whereas the variations between safety-net and non–safety-net hospitals had been small, they had been sufficient to have an effect on hospital rankings. New York is among the many states that makes use of in-hospital mortality to guage how hospitals carry out on sepsis high quality measures.
“Present or future state and federal high quality measures that use in-hospital mortality as a top quality metric could unfairly penalize safety-net hospitals,” corresponding creator Anica Legislation, MD, assistant professor of drugs at BU College of Medication, stated in a press launch.
Legislation and her colleagues say their findings can be utilized to information number of higher final result measures for publicly reported high quality benchmarks.