Hospital variations in severe sepsis mortality

Area of Science:

• Critical Care Medicine
• Health Services Research
• Epidemiology

Background:

• Severe sepsis is a life-threatening condition requiring effective hospital management.
• Significant variations in healthcare quality and patient outcomes exist across different medical institutions.
• Understanding these variations is crucial for improving sepsis care nationwide.

Purpose of the Study:

• To analyze and characterize the variability in severe sepsis mortality rates among hospitals within the United States.
• To compare observed severe sepsis mortality with expected mortality using risk adjustment models.
• To identify potential disparities in severe sepsis outcomes across a national consortium of academic medical centers.

Main Methods:

• Utilized 2012 hospital discharge data from the University HealthSystem Consortium (UHC).
• Defined severe sepsis using diagnosis codes indicating serious infection with organ dysfunction.
• Calculated observed-to-expected (O:E) mortality ratios based on UHC risk adjustment models.

Main Results:

• Analysis included 256,509 severe sepsis patients across 188 hospitals.
• Median severe sepsis cases per hospital were 1202 (IQR: 718-1940).
• Observed mortality rates (median: 8.6%) and O:E ratios (median: 0.91) showed wide variation (range: 0.9%-18.2% and 0.16-1.95, respectively).

Conclusions:

• Significant institutional variations in severe sepsis mortality and O:E ratios were identified.
• These findings underscore disparities in severe sepsis care and outcomes among major US medical centers.
• Further investigation is warranted to understand the drivers of these observed variations.