Braun LeeAnn, Riedel Aylin Atlan, Cooper Liesl Marie
Global Clinical Operations, Eli Lilly and Company, Indianapolis, IN 46285, USA.
J Manag Care Pharm. 2004 Nov-Dec;10(6):521-30. doi: 10.18553/jmcp.2004.10.6.521.
To determine severe sepsis (SS) incidence, hospital mortality, 1-year mortality, and costs associated with care in a sample of enrollees in a nationally representative individual practice association (IPA)-network managed care organization (MCO).
This was a retrospective analysis of administrative claims data for commercial (not managed Medicare) members. We identified MCO members hospitalized for SS between July 1995 and December 1998. SS cases were identified by a combination of ICD-9-CM codes for infection and organ dysfunction. Enrollment information, physician, facility, and pharmacy claims were analyzed. Subjects with continuous enrollment were followed for 1 full year of observation. Costs were health plan payments to providers, after subtraction of member cost-share amounts.
The incidence rate was 0.91 cases of SS per 1,000 enrollees, increasing with age. The mean age of SS patients was 50 years, and 53% were male. Approximately 63% received surgical intervention. Mortality was 21% during the first hospitalization and 36.1% at 1 year. During follow-up, 47.1% of survivors were rehospitalized. Mean index hospitalization length of stay and costs were 16 days and 26,820 dollars, with 1-year inpatient and outpatient costs totaling 48,996 dollars. Mean outpatient costs per survivor were 8,363 dollars, and mean per-patient-per-month (PPPM) outpatient costs were 906 dollars. Total follow-up costs including rehospitalization were similar for nonsurvivors compared with survivors (7,710 dollars versus 8,522 dollars, P=0.274), but PPPM costs were higher for nonsurvivors (1,760 dollars versus 699 dollars, P<0.001).
Incidence, hospital, and 1-year mortality rates were lower in this population compared with literature reports and were associated with a lower average age in this managed care population. Mean SS hospitalization costs were high, and nearly one half of survivors required rehospitalization within 1 year. Study results suggest the need to evaluate SS interventions for improvement in health outcomes and cost outcomes, particularly in postsurgical patients.
确定在一个具有全国代表性的个体执业协会（IPA）网络管理式医疗组织（MCO）的参保人群样本中，严重脓毒症（SS）的发病率、医院死亡率、1年死亡率以及护理相关费用。
这是一项对商业（非管理式医疗保险）成员行政索赔数据的回顾性分析。我们确定了1995年7月至1998年12月期间因SS住院的MCO成员。SS病例通过感染和器官功能障碍的ICD - 9 - CM编码组合来确定。对参保信息、医生、医疗机构和药房索赔进行了分析。对持续参保的受试者进行了为期1整年的观察。费用是健康计划向提供者支付的金额，减去成员的费用分摊额。
发病率为每1000名参保者中有0.91例SS病例，随年龄增长而增加。SS患者的平均年龄为50岁，53%为男性。约63%接受了手术干预。首次住院期间死亡率为21%，1年时为36.1%。在随访期间，47.1%的幸存者再次住院。平均首次住院时长和费用分别为16天和26,820美元，1年的住院和门诊费用总计48,996美元。每位幸存者的平均门诊费用为8,363美元，每位患者每月（PPPM）的门诊费用为906美元。与幸存者相比，非幸存者包括再次住院在内的总随访费用相似（7,710美元对8,522美元，P = 0.274），但非幸存者的PPPM费用更高（1,760美元对699美元，P < 0.001）。
与文献报道相比，该人群中的发病率、医院死亡率和1年死亡率较低，且与该管理式医疗人群的较低平均年龄相关。SS的平均住院费用较高，近一半的幸存者在1年内需要再次住院。研究结果表明需要评估SS干预措施以改善健康结局和成本结局，特别是在术后患者中。
