Journal article
Inter-hospital transfer is associated with increased mortality and costs in severe sepsis and septic shock: An instrumental variables approach
Journal of critical care, Vol.36, pp.187-194
12/2016
DOI: 10.1016/j.jcrc.2016.07.016
PMCID: PMC5097022
PMID: 27546770
Abstract
The objective of this study was to evaluate the impact of regionalization on sepsis survival, to describe the role of inter-hospital transfer in rural sepsis care, and to measure the cost of inter-hospital transfer in a predominantly rural state.
Observational case–control study using statewide administrative claims data from 2005 to 2014 in a predominantly rural Midwestern state. Mortality and marginal costs were estimated with multivariable generalized estimating equations models and with instrumental variables models.
A total of 18 246 patients were included, of which 59% were transferred between hospitals. Transferred patients had higher mortality and longer hospital length-of-stay than non-transferred patients. Using a multivariable generalized estimating equations (GEE) model to adjust for potentially confounding factors, inter-hospital transfer was associated with increased mortality (aOR 1.7, 95% CI 1.5–1.9). Using an instrumental variables model, transfer was associated with a 9.2% increased risk of death. Transfer was associated with additional costs of $6897 (95% CI $5769–8024). Even when limiting to only those patients who received care in the largest hospitals, transfer was still associated with $5167 (95% CI $3696–6638) in additional cost.
The majority of rural sepsis patients are transferred, and these transferred patients have higher mortality and significantly increased cost of care.
Details
- Title: Subtitle
- Inter-hospital transfer is associated with increased mortality and costs in severe sepsis and septic shock: An instrumental variables approach
- Creators
- Nicholas M Mohr - Department of Emergency Medicine, Division of Critical Care, Department of Anesthesia, University of Iowa Carver College of Medicine, 200 Hawkins Drive, 1008 RCP, Iowa City, IA 52242Karisa K Harland - Department of Emergency Medicine, University of Iowa Carver College of Medicine, 200 Hawkins Drive, 1008 RCP, Iowa City, IA 52242Dan M Shane - Department of Health Management and Policy, University of Iowa College of Public Health, 145 N. Riverside Drive, N244 CPHB, Iowa City, IA 52242Azeemuddin Ahmed - Department of Emergency Medicine, University of Iowa Carver College of Medicine, 200 Hawkins Drive, 1008 RCP, Iowa City, IA 52242Brian M Fuller - Division of Critical Care, Department of Anesthesia, Division of Emergency Medicine, One Brookings Drive, CB 8072, St. Louis, MO 63130James C Torner - Department of Epidemiology, University of Iowa College of Public Health, 145 N. Riverside Drive, S441A CPHB, Iowa City, IA 52242
- Resource Type
- Journal article
- Publication Details
- Journal of critical care, Vol.36, pp.187-194
- DOI
- 10.1016/j.jcrc.2016.07.016
- PMID
- 27546770
- PMCID
- PMC5097022
- NLM abbreviation
- J Crit Care
- ISSN
- 0883-9441
- eISSN
- 1557-8615
- Publisher
- Elsevier Inc
- Language
- English
- Date published
- 12/2016
- Academic Unit
- Health Management and Policy; Management and Entrepreneurship ; Epidemiology; Economics; Emergency Medicine; Surgery; Anesthesia; Injury Prevention Research Center; Public Policy Center (Archive); Neurosurgery; Law Faculty
- Record Identifier
- 9983995165702771
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