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Inter-hospital transfer is associated with increased mortality and costs in severe sepsis and septic shock: An instrumental variables approach.

Abstract：

PURPOSE: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. MATERIALS AND METHODS: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. RESULTS: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. CONCLUSIONS:The majority of rural sepsis patients are transferred, and these transferred patients have higher mortality and significantly increased cost of care.

journal_name

J Crit Care

journal_title

Journal of critical care

authors

Mohr NM,Harland KK,Shane DM,Ahmed A,Fuller BM,Torner JC

doi

10.1016/j.jcrc.2016.07.016

subject

Has Abstract

pub_date

2016-12-01 00:00:00

pages

187-194

eissn

0883-9441

issn

1557-8615

pii

S0883-9441(16)30253-2

journal_volume

36

pub_type

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