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Hospital Readmissions for Sepsis Take Toll on Health Care System

UCLA researchers find sepsis more costly than heart attack, heart failure combined

The Patient Protection and Affordable Care Act created several national initiatives aimed at reducing hospital readmission rates for heart attacks, congestive heart failure (CHF), and other common high-risk conditions. But there is still no national program intended to address sepsis, a potentially life-threatening illness.

A new study from the University of California, Los Angeles (UCLA) has found that sepsis accounts for roughly the same percentage of hospital readmissions in California as heart attacks and CHF — and that it costs the health care system more than both of them combined. The research, conducted by the UCLA Clinical and Translational Science Institute, was  published online in Critical Care Medicine.

“Our study shows how common sepsis readmissions are and some of the factors that are associated with higher risk of readmission after these severe infections,” said lead author Dr. Dong Chang. “In addition, we show that sepsis readmissions have a significant impact on health care expenditures relative to other high-risk conditions that are receiving active attention and interventions. Based on these results, we believe that sepsis readmissions are under-recognized and should be among the conditions that are targeted for intervention by policymakers.”

The researchers analyzed admissions for adults (18 years of age and older) for sepsis at all California hospitals from 2009 through 2011, and during the same period for CHF and heart attacks. There were a total of 240,198 admissions for sepsis; 193,153 for CHF; and 105,684 for heart attacks.

The authors found that the all-cause 30-day readmission rate for sepsis was 20.4%. The readmission rates for CHF and heart attacks were 23.6% and 17.7%, respectively.

The study showed that people with sepsis were readmitted because of respiratory failure; pneumonia; complications with devices, implants, or grafts; urinary-tract infections; renal infections; renal failure; and intestinal infections, among other causes.

The study also revealed that readmission rates were higher among young adults than older adults, higher among men than women, higher among black and Native American patients than other racial groups, and higher among lower-income patients than those with higher incomes. In addition, people with other concurrent health problems were more likely to be readmitted than were those with sepsis alone.

The estimated annual cost of sepsis-related readmissions in California during the study period was $500 million compared with $229 million for CHF and $142 million for heart attacks.

“These findings suggest that efforts to reduce hospital readmissions need to include sepsis prominently, at least on par with heart failure and myocardial infarction,” said lead investigator Dr. Martin Shapiro.

The next stage of the research will be to examine why patients are readmitted after sepsis and the percentage of those readmissions that are due to processes that can be improved upon, such as discharge practices, follow-up care, and teaching patients how to take their medications.

The authors noted some limitations to their study. For instance, they used claims data based on hospital codes for patient diagnoses; there is little research into the accuracy of this coding when comparing CHF, heart attacks, and sepsis. In addition, the analysis was limited to California hospitals, and the data may vary in other parts of the U.S.

Source: UCLA; July 7, 2015.

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