Risk-standardized sepsis mortality map of the United States
Open Access
- 20 January 2022
- journal article
- research article
- Published by SAGE Publications in Digital Health
Abstract
Objective Sepsis is the leading cause of in-hospital mortality in the United States (US). Quality improvement initiatives for improving sepsis care depend on accurate estimates of sepsis mortality. While hospital 30-day risk-standardized mortality rates have been published for patients hospitalized with acute myocardial infarction, heart failure, and pneumonia, risk-standardized mortality rates for sepsis have not been well characterized. We aimed to construct a sepsis risk-standardized mortality rate map for the United States, to illustrate disparities in sepsis care across the country. Methods This cross-sectional study included adults from the US Nationwide Inpatient Sample who were hospitalized with sepsis between 1 January 2010 and 30 December 2011. Hospital-level risk-standardized mortality rates were calculated using hierarchical logistic modelling, and were risk-adjusted with predicted mortality derived from (1) the Sepsis Risk Prediction Score, a logistic regression model, and (2) gradient-boosted decision trees, a supervised machine learning (ML) algorithm. Results Among 1,739,033 adults hospitalized with sepsis, 50% were female, and the median age was 71 years (interquartile range: 58-81). The national median risk-standardized mortality rate for sepsis was 18.4% (interquartile range: 17.0, 21.0) by the boosted tree model, which had better discrimination than the Sepsis Risk Prediction Score model (C-statistic 0.87 and 0.78, respectively). The highest risk-standardized mortality rates were found in Wyoming, North Dakota, and Mississippi, while the lowest were found in Arizona, Colorado, and Michigan. Conclusions Wide variation exists in sepsis risk-standardized mortality rates across states, representing opportunities for improvement in sepsis care. This represents the first map of state-level variation of risk-standardized mortality rates in sepsis.Funding Information
- Taiwan Ministry of Science and Technology (Grant 105-2811-B-002-031)
This publication has 51 references indexed in Scilit:
- Insurance and racial differences in long-term acute care utilization after critical illness*Critical Care Medicine, 2012
- A combined comorbidity score predicted mortality in elderly patients better than existing scoresJournal of Clinical Epidemiology, 2011
- Variability in the Measurement of Hospital-wide Mortality RatesThe New England Journal of Medicine, 2010
- National Patterns of Risk-Standardized Mortality and Readmission for Acute Myocardial Infarction and Heart FailureCirculation: Cardiovascular Quality and Outcomes, 2010
- Accountability Measures — Using Measurement to Promote Quality ImprovementThe New England Journal of Medicine, 2010
- National variation in United States sepsis mortality: a descriptive studyInternational Journal of Health Geographics, 2010
- Patterns of Hospital Performance in Acute Myocardial Infarction and Heart Failure 30-Day Mortality and ReadmissionCirculation: Cardiovascular Quality and Outcomes, 2009
- What is the empirical evidence that hospitals with higher-risk adjusted mortality rates provide poorer quality care? A systematic review of the literatureBMC Health Services Research, 2007
- The Epidemiology of Sepsis in the United States from 1979 through 2000The New England Journal of Medicine, 2003
- Early Goal-Directed Therapy in the Treatment of Severe Sepsis and Septic ShockThe New England Journal of Medicine, 2001