Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Internal Medicine, The Ohio State University College of Medicine, Columbus, OH.
Department of Internal Medicine, Center for Health Outcomes in Medicine Scholarship and Service (HOMES), The Ohio State University Wexner Medical Center, Columbus, OH.
Crit Care Med. 2024 Nov 1;52(11):1729-1738. doi: 10.1097/CCM.0000000000006397. Epub 2024 Aug 13.
Sepsis survivors have greater healthcare use than those surviving hospitalizations for other reasons, yet factors associated with greater healthcare use in this population remain ill-defined. Rural Americans are older, have more chronic illnesses, and face unique barriers to healthcare access, which could affect postsepsis healthcare use. Therefore, we compared healthcare use and expenditures among rural and urban sepsis survivors. We hypothesized that rural survivors would have greater healthcare use and expenditures.
DESIGN, SETTING, AND PATIENTS: To test this hypothesis, we used data from 106,189 adult survivors of a sepsis hospitalization included in the IBM MarketScan Commercial Claims and Encounters database and Medicare Supplemental database between 2013 and 2018.
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We identified hospitalizations for severe sepsis and septic shock using the International Classification of Diseases , 9th Edition (ICD-9) or 1CD-10 codes. We used Metropolitan Statistical Area classifications to categorize rurality. We measured emergency department (ED) visits, inpatient hospitalizations, skilled nursing facility admissions, primary care visits, physical therapy visits, occupational therapy visits, and home healthcare visits for the year following sepsis hospitalizations. We calculated the total expenditures for each of these categories. We compared outcomes between rural and urban patients using multivariable regression and adjusted for covariates. After adjusting for age, sex, comorbidities, admission type, insurance type, U.S. Census Bureau region, employment status, and sepsis severity, those living in rural areas had 17% greater odds of having an ED visit (odds ratio [OR] 1.17; 95% CI, 1.13-1.22; p < 0.001), 9% lower odds of having a primary care visit (OR 0.91; 95% CI, 0.87-0.94; p < 0.001), and 12% lower odds of receiving home healthcare (OR 0.88; 95% CI, 0.84-0.93; p < 0.001). Despite higher levels of ED use and equivalent levels of hospital readmissions, expenditures in these areas were 14% (OR 0.86; 95% CI, 0.80-0.91; p < 0.001) and 9% (OR 0.91; 95% CI, 0.87-0.96; p < 0.001) lower among rural survivors, respectively, suggesting these services may be used for lower-acuity conditions.
In this large cohort study, we report important differences in healthcare use and expenditures between rural and urban sepsis survivors. Future research and policy work is needed to understand how best to optimize sepsis survivorship across the urban-rural continuum.
脓毒症幸存者比因其他原因住院的幸存者使用更多的医疗保健服务，但该人群中与更多医疗保健使用相关的因素仍未得到明确界定。美国农村居民年龄更大，患有更多的慢性疾病，并且面临独特的医疗保健获取障碍，这可能会影响脓毒症后的医疗保健使用。因此，我们比较了农村和城市脓毒症幸存者的医疗保健使用和支出。我们假设农村幸存者的医疗保健使用和支出会更大。
设计、地点和患者：为了验证这一假设，我们使用了 2013 年至 2018 年间 IBM MarketScan 商业索赔和就诊数据库和 Medicare 补充数据库中 106189 名脓毒症住院幸存者的数据。
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我们使用国际疾病分类第 9 版（ICD-9）或第 10 版（ICD-10）代码来确定严重脓毒症和败血症休克的住院治疗。我们使用大都市统计区分类来对农村地区进行分类。我们测量了脓毒症住院后一年内的急诊就诊、住院治疗、熟练护理设施入院、初级保健就诊、物理治疗就诊、职业治疗就诊和家庭保健就诊。我们计算了这些类别的总支出。我们使用多变量回归比较了农村和城市患者的结果，并调整了协变量。在调整了年龄、性别、合并症、入院类型、保险类型、美国人口普查局区域、就业状况和脓毒症严重程度后，居住在农村地区的患者急诊就诊的可能性增加 17%（优势比[OR]1.17；95%CI，1.13-1.22；p < 0.001），初级保健就诊的可能性降低 9%（OR 0.91；95%CI，0.87-0.94；p < 0.001），家庭保健就诊的可能性降低 12%（OR 0.88；95%CI，0.84-0.93；p < 0.001）。尽管农村地区的急诊就诊水平较高，而住院再入院率相同，但这些地区的支出分别降低了 14%（OR 0.86；95%CI，0.80-0.91；p < 0.001）和 9%（OR 0.91；95%CI，0.87-0.96；p < 0.001），这表明这些服务可能用于更轻度的疾病。
在这项大型队列研究中，我们报告了农村和城市脓毒症幸存者在医疗保健使用和支出方面的重要差异。需要进一步的研究和政策工作来了解如何在城乡范围内优化脓毒症的生存状况。
