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Healthcare Associated Infections II: Preventive Measures01:22

Healthcare Associated Infections II: Preventive Measures

Essential infection prevention measures are based on the knowledge of the infection chain, the modes of transmission in healthcare settings, and the use of the best practices in all healthcare settings. Compulsory public reporting of healthcare-associated infection rates is needed to allow individuals and the community to make informed choices regarding selecting a healthcare facility.
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Hospitals offer medical and surgical care to the sick and injured, along with accommodation while they recover. At the same time, they also provide outpatient, emergency, psychiatric, and rehabilitation services to meet various community needs. In addition to providing medical care, hospitals also act as hubs for medical research and training. Hospitals use clinical procedures and evidence-based practice standards to deliver patient care. To deliver safe and efficient care, a nurse must stay up...
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Related Experiment Videos

The Association Between Sepsis Coding and Payment to U.S. Hospitals.

Andrew M Ryan1, Hallie C Prescott2, Yan Lin1

  • 1Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, Rhode Island, USA.

Health Services Research
|June 24, 2026
PubMed
Summary

Nearly a quarter of sepsis hospitalizations in Traditional Medicare may not meet Sepsis-3 criteria, leading to increased healthcare spending. Aligning coding guidelines with clinical definitions could reduce costs.

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Area of Science:

  • Healthcare economics
  • Infectious disease epidemiology
  • Health services research

Background:

  • Sepsis diagnosis and classification are critical for patient care and resource allocation.
  • The Sepsis-3 definition aims to standardize sepsis identification based on organ dysfunction.
  • Understanding the concordance of clinical practice with Sepsis-3 criteria is essential for accurate healthcare assessment.

Purpose of the Study:

  • To determine the prevalence of Sepsis-3 concordant and discordant sepsis hospitalizations within Traditional Medicare.
  • To evaluate the financial impact of Sepsis-3 discordant hospitalizations on Medicare spending.
  • To identify common alternative diagnoses associated with Sepsis-3 discordant sepsis cases.

Main Methods:

  • A retrospective observational study utilizing a 100% sample of Traditional Medicare inpatient claims from 2016 to 2022.
  • Inclusion of acute care hospitals under the Inpatient Prospective Payment System, excluding specific regions.
  • Classification of sepsis hospitalizations (identified by DRGs 870-872) as Sepsis-3 concordant or discordant based on the presence of acute organ dysfunction diagnosis codes.

Main Results:

  • Approximately 22.6% of 4.2 million sepsis hospitalizations lacked acute organ dysfunction codes, classifying them as Sepsis-3 discordant.
  • Common alternative diagnoses for discordant hospitalizations included pneumonia, urinary tract infections, and skin infections.
  • Sepsis-3 discordant hospitalizations had significantly lower 30-day mortality (7.7%) compared to concordant ones (33.4%).
  • Discordant hospitalizations incurred an average of $839 more per case than simple infections, totaling an estimated $114 million in excess annual payments.

Conclusions:

  • A substantial proportion of inpatient sepsis hospitalizations in Traditional Medicare may not align with Sepsis-3 criteria.
  • This discordance contributes significantly to increased healthcare expenditures.
  • Recommendations include aligning ICD-10 coding guidelines with clinical definitions to improve accuracy and potentially reduce costs.