CRISMA Center, Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA.
Division of General Internal Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, PA.
Crit Care Med. 2020 Oct;48(10):1411-1418. doi: 10.1097/CCM.0000000000004514.
Initial evidence suggests that state-level regulatory mandates for sepsis quality improvement are associated with decreased sepsis mortality. However, sepsis mandates require financial investments on the part of hospitals and may lead to increased spending. We evaluated the effects of the 2013 New York State sepsis regulations on the costs of care for patients hospitalized with sepsis.
Retrospective cohort study using state discharge data from the U.S. Healthcare Costs and Utilization Project and a comparative interrupted time series analytic approach. Costs were calculated from admission-level charge data using hospital-specific cost-to-charge ratios.
General, short stay, acute care hospitals in New York, and four control states: Florida, Massachusetts, Maryland, and New Jersey.
All patients hospitalized with sepsis between January 1, 2011, and September 30, 2015.
The 2013 New York mandate that all hospitals develop and implement protocols for sepsis identification and treatment, educate staff, and report performance data to the state.
The analysis included 1,026,664 admissions in 520 hospitals. Mean unadjusted costs per hospitalization in New York State were $42,036 ± $60,940 in the pre-regulation period and $39,719 ± $59,063 in the post-regulation period, compared with $34,642 ± $52,403 pre-regulation and $31,414 ± $48,155 post-regulation in control states. In the comparative interrupted time series analysis, the regulations were not associated with a significant difference in risk-adjusted mean cost per hospitalization (p = 0.12) or risk-adjusted mean cost per hospital day (p = 0.44). For example, in the 10th quarter after implementation of the regulations, risk-adjusted mean cost per hospitalization was $3,627 (95% CI, -$681 to $7,934) more than expected in New York State relative to control states.
Mandated protocolized sepsis care was not associated with significant changes in hospital costs in patients hospitalized with sepsis in New York State.
初步证据表明，州级监管机构对脓毒症质量改进的监管要求与降低脓毒症死亡率有关。然而，脓毒症的监管要求医院进行财政投资，可能会导致支出增加。我们评估了 2013 年纽约州脓毒症法规对因脓毒症住院患者的治疗费用的影响。
使用美国医疗保健成本和利用项目的州级出院数据进行回顾性队列研究，并采用比较中断时间序列分析方法。使用医院特定的成本与收费比率，根据入院收费数据计算成本。
纽约州的普通、短期、急性护理医院，以及四个对照州：佛罗里达州、马萨诸塞州、马里兰州和新泽西州。
2011 年 1 月 1 日至 2015 年 9 月 30 日期间因脓毒症住院的所有患者。
2013 年纽约州的规定要求所有医院制定和实施脓毒症识别和治疗方案，对员工进行教育，并向州政府报告绩效数据。
该分析包括 520 家医院的 1,026,664 例住院。在监管前期间，纽约州每例住院的未调整平均费用为 42036 美元±60940 美元，而在监管后期间为 39719 美元±59063 美元，而在对照州，监管前期间为 34642 美元±52403 美元，监管后期间为 31414 美元±48155 美元。在比较中断时间序列分析中，监管规定与每例住院的风险调整后平均费用（p = 0.12）或每例住院的风险调整后平均费用（p = 0.44）均无显著差异。例如，在实施规定后的第 10 个季度，与对照州相比，纽约州每例住院的风险调整后平均费用为 3627 美元（95%CI，-681 至 7934 美元）。
在纽约州因脓毒症住院的患者中，强制性脓毒症规范化治疗方案与医院费用的显著变化无关。
