Hospital Spending and Patient Outcomes for Sepsis

Previous studies have found that regions of the United States with high rates of healthcare spending have poorer adherence to quality-of-care measures, worse clinical outcomes, and lower patient and physician satisfaction compared with low-cost areas. Current healthcare reform efforts have suggested that as much as one third of all government spending on healthcare could be eliminated without negatively affecting patient outcomes. Due to a lack of detailed information about which hospital and physician practice patterns lead to high-value care, researchers acknowledge that it is difficult to turn observations about regional spending patterns and regional outcomes into specific recommendations on the reduction of healthcare cost. Sepsis, a common, highly morbid, and costly condition is a model condition for examining the relationship between hospital spending and outcomes, the researchers of a recent study stated. They noted that the mortality rate of patients with sepsis is nearly 20%; annual costs associated with sepsis care are estimated at $17 billion. In addition, sepsis often involves multiple systems, requiring complex care that requires coordination of multiple disciplines throughout the hospital. Finally, sepsis is an acute condition that lends itself to studies of acute care hospitalizations. To identify variations in hospital costs and hospital mortality rates of patients with sepsis and to assess whether higher spending is associated with better outcomes, researchers recently conducted a cross-sectional study of hospitals that treated at least 100 adult patients with sepsis between 2004 and 2006. They reported study results in Archives of Internal Medicine [2011;171(4):292-299]. There were 309 hospitals in the analysis, representing 166,931 patients during the study period (range, 103-1932 patients per hospital). Two thirds of the hospitals (67%) were not engaged in house staff training, 80% operated >200 beds, 84% were located in urban areas, and 49% were in the southern United States. Median patient age was 70 years,51% were female, and 62% were white. Approximately two thirds (63%) of the patients were Medicare beneficiaries, approximately one third (35%) had hypertension and/or diabetes (33%), and 25% had chronic obstructive pulmonary disease. The most prevalent sites of infection were urinary tract (38%) and lung (32%); 83% were medical versus surgical patients. Thirty-six percent of the patients were admitted to the intensive care unit within 2 days of hospitalization and 15% were placed on mechanical ventilation. The median unadjusted hospital mean cost per case was $18,256. The expected mortality rate for all hospitals was 19.2%; among the 61 hospitals with expected mortality between 18.5% and 19.5%, observed mortality ranged from 9.2% to 32.3%. Overall, 21% of the hospitals (n=66) had a clinically and statistically significant higher-than-expected mortality rate. There were 20 hospitals between 10% and 25% above expected mortality rate and 46 hospitals with observed mortality exceeding predicted mortality by >25%. The median average expected cost per case at the hospital level (fixed effects only) was $18,659; of the 42 hospitals with expected costs within $500 of this amount, actual mean costs ranged from $12,271 to $37,095. More than a third (34%) of hospitals exceeded expected costs by at least 10%; median average cost was $5207. Twenty-two hospitals (7%) had lower-than-expected costs and mortality rates. In conclusion, the researchers summarized that “hospital spending and adjusted mortality rates for patients with sepsis vary substantially, but higher hospital expenditures are not associated with better survival. Efforts to enhance the value of sepsis care could be modeled on hospitals that achieve lower-than-expected mortality and costs.”