Department of Internal Medicine, University of Michigan, Ann Arbor, MI.
VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI.
Crit Care Med. 2018 May;46(5):666-673. doi: 10.1097/CCM.0000000000003005.
Under "Rory's Regulations," New York State Article 28 acute care hospitals were mandated to implement sepsis protocols and report patient-level data. This study sought to determine how well cases reported under state mandate align with discharge records in a statewide administrative database.
Observational cohort study.
First 27 months of mandated sepsis reporting (April 1, 2014, to June 30, 2016).
Hospitalizations with sepsis at New York State Article 28 acute care hospitals.
Sepsis regulations with mandated reporting.
We compared cases reported to the New York State Department of Health Sepsis Clinical Database with discharge records in the Statewide Planning and Research Cooperative System database. We classified discharges as 1) "coded sepsis discharges"-a diagnosis code for severe sepsis or septic shock and 2) "possible sepsis discharges," using Dombrovskiy and Angus criteria. Of 111,816 sepsis cases reported to the New York State Department of Health Sepsis Clinical Database, 105,722 (94.5%) were matched to discharge records in Statewide Planning and Research Cooperative System. The percentage of coded sepsis discharges reported increased from 67.5% in the first quarter to 81.3% in the final quarter of the study period (mean, 77.7%). Accounting for unmatched cases, as many as 82.7% of coded sepsis discharges were potentially reported, whereas at least 17.3% were unreported. Compared with unreported discharges, reported discharges had higher rates of acute organ dysfunction (e.g., cardiovascular dysfunction 63.0% vs 51.8%; p < 0.001) and higher in-hospital mortality (30.2% vs 26.1%; p < 0.001). Hospital characteristics (e.g., number of beds, teaching status, volume of sepsis cases) were similar between hospitals with a higher versus lower percent of discharges reported, p values greater than 0.05 for all. Hospitals' percent of discharges reported was not correlated with risk-adjusted mortality of their submitted cases (Pearson correlation coefficient 0.11; p = 0.17).
Approximately four of five discharges with a diagnosis code of severe sepsis or septic shock in the Statewide Planning and Research Cooperative System data were reported in the New York State Department of Health Sepsis Clinical Database. Incomplete reporting appears to be driven more by underrecognition than attempts to game the system, with minimal bias to risk-adjusted hospital performance measurement.
根据“罗里条例”，纽约州第 28 条急性护理医院被要求实施脓毒症方案并报告患者水平数据。本研究旨在确定在州授权下报告的病例与全州行政数据库中的出院记录吻合的程度。
观察性队列研究。
授权报告脓毒症的前 27 个月（2014 年 4 月 1 日至 2016 年 6 月 30 日）。
在纽约州第 28 条急性护理医院发生脓毒症的住院患者。
脓毒症法规和强制性报告。
我们将向纽约州卫生部脓毒症临床数据库报告的病例与全州规划和研究合作系统数据库中的出院记录进行比较。我们使用多布罗夫斯基和安格斯标准将出院分为 1）“编码脓毒症出院”-严重脓毒症或脓毒性休克的诊断代码和 2）“可能的脓毒症出院”。在向纽约州卫生部脓毒症临床数据库报告的 111816 例脓毒症病例中，有 105722 例（94.5%）与全州规划和研究合作系统数据库中的出院记录相匹配。报告的编码脓毒症出院比例从研究期第一季度的 67.5%增加到最后一个季度的 81.3%（平均 77.7%）。考虑到未匹配的病例，多达 82.7%的编码脓毒症出院可能被报告，而至少有 17.3%未被报告。与未报告的出院相比，报告的出院急性器官功能障碍发生率更高（例如，心血管功能障碍 63.0%比 51.8%；p<0.001），院内死亡率更高（30.2%比 26.1%；p<0.001）。报告出院比例较高的医院与报告出院比例较低的医院之间，医院特征（例如，床位数、教学地位、脓毒症病例量）相似，p 值均大于 0.05。医院报告出院比例与提交病例的风险调整死亡率之间没有相关性（皮尔逊相关系数 0.11；p=0.17）。
在全州规划和研究合作系统数据中，有严重脓毒症或脓毒性休克诊断代码的出院病例中，约有四分之五在纽约州卫生部脓毒症临床数据库中报告。未报告的情况似乎更多是由于识别不足，而不是试图操纵系统，对风险调整后的医院绩效测量几乎没有偏差。
