Inova Fairfax Hospital
Introduction: Patients with sepsis continue to have high morbidity, mortality and costs. We studied impact of hospital size, location and organizational characteristics on costs and outcomes in patients with sepsis.
Hypothesis: Hospital organizational characteristics, size and location impact cost and outcome of patients with sepsis.
Methods: We analyzed NIS database for all adult sepsis discharges from 2005 to 2009. Hospitals were divided in quintiles by average cost per septic patient. Univariate and multivariate analysis was used to compare mortality and length of stay (LOS) for each quintile by hospital cost, their size, location and organizational characteristics.
Results: During 2005-09 period there were 1,093,686 sepsis discharges. Univariate analysis revealed that hospitals in higher cost quintiles admitted more non-white, male patients, who were younger but with more comorbidities, secondary diagnosis, failed organs and higher severity of disease. These hospitals were more likely to be large, urban and teaching facilities. Patients in these hospitals had more diagnostic and therapeutic procedures preformed. When comparing lowest and highest cost quintiles, hospital mortality increased from 13.2 +/- 0.5% to 25.1 +/- 0.4% and LOS from 5 +/- 0.2 days to 16.5 +/- 0.2 days. Hospitals in lower cost quintiles were more likely to transfer patients to another hospital (p for all comparisons < 0.0001). In multivariate analysis hospital mortality and LOS decreased during 2005-09 period. Younger age and higher income were associated with lower LOS and mortality. Higher severity of disease continued to be significantly associated with higher LOS and mortality. Large, urban and teaching hospitals had lower mortality and small hospitals had highest LOS and mortality (p < 0.05 for all comparisons).
Conclusions: Outcomes in patients with sepsis depend on demographic and socioeconomic variables. In addition outcomes depend on size, location and organizational characteristic of hospitals. Identifying hospitals with best outcomes, lowest costs and analyzing processes implemented by these hospitals in care of septic patients could both improve outcomes and reduce costs in this population.