Biomedical Advanced Research and Development Authority, Office of the Assistant Secretary for Preparedness and Response, U.S. Department of Health and Human Services, Washington, DC.
Emory Critical Care Center, Emory University, Atlanta, GA.
Crit Care Med. 2020 Mar;48(3):302-318. doi: 10.1097/CCM.0000000000004225.
To evaluate the impact of sepsis, age, and comorbidities on death following an acute inpatient admission and to model and forecast inpatient and skilled nursing facility costs for Medicare beneficiaries during and subsequent to an acute inpatient sepsis admission.
Analysis of paid Medicare claims via the Centers for Medicare & Medicaid Services DataLink Project (CMS) and leveraging the CMS-Hierarchical Condition Category risk adjustment model.
All U.S. acute care hospitals, excepting federal hospitals (Veterans Administration and Defense Health Agency).
All Part A/B (fee-for-service) Medicare beneficiaries with an acute inpatient admission in 2017 and who had no inpatient sepsis admission in the prior year.
None.
Logistic regression models to determine covariate risk contribution to death following an acute inpatient admission; conventional regression to predict Medicare beneficiary sepsis costs. Using the Hierarchical Condition Category risk adjustment model to illuminate influence of illness on outcome of inpatient admissions, representative odds ratios (with 95% CIs) for death within 6 months of an admission (referenced to beneficiaries admitted but without the characteristic) are as follows: septic shock, 7.27 (7.19-7.35); metastatic cancer and acute leukemia (Hierarchical Condition Category 8), 6.76 (6.71-6.82); all sepsis, 2.63 (2.62-2.65); respiratory arrest (Hierarchical Condition Category 83), 2.55 (2.35-2.77); end-stage liver disease (Hierarchical Condition Category 27), 2.53 (2.49-2.56); and severe sepsis without shock, 2.48 (2.45-2.51). Models of the cost of sepsis care for Medicare beneficiaries forecast arise approximately 13% over 2 years owing the rising enrollments in Medicare offset by the cost of care per admission.
A sepsis inpatient admission is associated with marked increase in risk of death that is comparable to the risks associated with inpatient admissions for other common and serious chronic illnesses. The aggregate costs of sepsis care for Medicare beneficiaries will continue to increase.
评估脓毒症、年龄和合并症对急性住院患者死亡的影响，并建立模型预测 Medicare 受益人的住院和熟练护理设施成本，以评估急性住院脓毒症患者的费用。
通过医疗保险和医疗补助服务数据链接项目（CMS）分析支付的医疗保险索赔，并利用 CMS 层次条件类别风险调整模型。
美国所有急性护理医院，不包括联邦医院（退伍军人管理局和国防卫生局）。
所有在 2017 年接受急性住院治疗且前一年无住院脓毒症患者的 Medicare 计划 A/B（按服务收费）的 Medicare 受益人的数据。
无。
使用逻辑回归模型确定死亡的协变量风险贡献，以确定死亡的协变量风险贡献；使用常规回归预测 Medicare 受益人的脓毒症成本。使用层次条件类别风险调整模型来阐明疾病对住院患者结局的影响，以分层条件类别（Hierarchical Condition Category）为参照的，脓毒症患者的入院后 6 个月内死亡的代表性比值比（95%CI）如下：感染性休克，7.27（7.19-7.35）；转移性癌症和急性白血病（分层条件类别 8），6.76（6.71-6.82）；所有脓毒症，2.63（2.62-2.65）；呼吸停止（分层条件类别 83），2.55（2.35-2.77）；终末期肝病（分层条件类别 27），2.53（2.49-2.56）；无休克的严重脓毒症，2.48（2.45-2.51）。 Medicare 受益人的脓毒症护理费用模型预测，由于 Medicare 参保人数的增加，导致成本增加约 13%，但由于每次住院的护理成本降低，因此成本有所降低。
脓毒症住院患者的死亡风险显著增加，与其他常见严重慢性疾病住院患者的死亡风险相当。 Medicare 受益人的脓毒症护理费用总额将继续增加。
