Journal article
Geographic Clusters in Sepsis Hospital Mortality and the Role of Targeted Regionalization
Critical care medicine, Vol.53(7), pp.e1365-e1376
07/2025
DOI: 10.1097/CCM.0000000000006678
PMCID: PMC12213171
PMID: 40272220
Abstract
Sepsis is a severe condition associated with high mortality, and hospital performance is variable. The objective of this study was to develop geospatial sepsis clusters, identify sources of variation between clusters, and test the hypothesis that redistributing sepsis patients from low-performing hospitals to higher-performing hospitals within a cluster will improve sepsis outcomes.
We conducted a cohort study of age-qualifying Medicare beneficiaries using administrative claims data from 2013 to 2015. We calculated risk-standardized mortality for hospitals then used a clustering algorithm to define geospatial cluster boundaries based on care-seeking and interhospital transfer patterns. Finally, we used simulation to model the effect of reallocating sepsis patients to higher-performing hospitals within the same cluster.
None.
We included 1,125,308 patients, and they were grouped into 222 regional clusters. High-performing clusters were located largely in the Midwest, and they tended to be in less urban regions with smaller hospitals. In our simulation, the most impactful strategy was reassigning cases from the lowest-performing hospital in a cluster to the highest-performing hospital in the cluster, which was predicted to prevent 1705 deaths per year in the United States. This aggregate benefit was lower than the 5702 deaths predicted from reducing mortality by 1% absolute in hospitals in the lower half of the performance distribution.
Geospatial clusters provide insight into regional approaches to system-based acute care. In a simulation study, targeted sepsis regionalization appears less effective than local performance improvement in reducing preventable sepsis deaths.
Details
- Title: Subtitle
- Geographic Clusters in Sepsis Hospital Mortality and the Role of Targeted Regionalization
- Creators
- Nicholas M Mohr - Departments of Emergency Medicine, Anesthesia Critical Care, and Epidemiology, University of Iowa Carver College of Medicine, Iowa City, IAYiqi Tang - Colby CollegeDavid F Gaieski - University of Pittsburgh School of MedicineDavid G Buckler - Icahn School of Medicine at Mount SinaiBrendan Carr - Icahn School of Medicine at Mount SinaiAlexis Zebrowski - Icahn School of Medicine at Mount Sinai
- Resource Type
- Journal article
- Publication Details
- Critical care medicine, Vol.53(7), pp.e1365-e1376
- DOI
- 10.1097/CCM.0000000000006678
- PMID
- 40272220
- PMCID
- PMC12213171
- NLM abbreviation
- Crit Care Med
- ISSN
- 1530-0293
- eISSN
- 1530-0293
- Publisher
- Lippincott Williams & Wilkins; PHILADELPHIA
- Grant note
- National Institutes of HealthAgency for Healthcare Research and Quality (AHRQ): R01HL141841, R01HS023614 AHRQ: K08HS025753 Scientific Computing and Data Center at the Icahn School of Medicine at Mount SinaiNational Center for Advancing Translational Sciences: UL1TR004419 Office of Research Infrastructure of the National Institutes of Health: S10OD026880, S10OD030463
This study was supported by the National Institutes of Health and the Agency for Healthcare Research and Quality (AHRQ) through the following two projects: R01HL141841 (National Heart, Lung, and Blood Institute) and R01HS023614 (AHRQ). Dr. Mohr was additionally supported by AHRQ (K08HS025753). This work was supported in part through the computational and data resources and staff expertise provided by the Scientific Computing and Data Center at the Icahn School of Medicine at Mount Sinai and supported by the Clinical and Translational Science Awards grant UL1TR004419 from the National Center for Advancing Translational Sciences. This research was also supported by the Office of Research Infrastructure of the National Institutes of Health under award number S10OD026880 and S10OD030463.
- Language
- English
- Electronic publication date
- 04/24/2025
- Date published
- 07/2025
- Academic Unit
- Epidemiology; Emergency Medicine; Anesthesia; Injury Prevention Research Center
- Record Identifier
- 9984813291402771
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