Higher Hospital Spending Does Not Result in Lower Adjusted Mortality in Sepsis

1Baystate Medical Center, Springfield, MA
2Baystate Medical Center, Springfield, MA
3Optistatim, LLC, Longmeadow, MA
4Baystate Medical Center, Springfield, MA
5Baystate Medical Center, Springfield, MA
6Baystate Medical Center, Springfield, MA

Meeting: Hospital Medicine 2010, April 8-11, Washington, D.C.

Abstract number: 84

Background:

Sepsis is a common, highly morbid, costly condition, yet little is known about hospital‐level variation in treatment costs or outcomes. We aimed to characterize variations in hospital costs and mortality rates for patients with sepsis and to determine whether higher levels of hospital spending were associated with lower adjusted mortality rates.

Methods:

We conducted a cross‐sectional study of 309 hospitals that cared for 100 or more sepsis patients between 2004 and 2006. We developed multivariable models to calculate expected patient mortality and costs, which we aggregated to create hospital‐level expected costs and mortality rates. We defined clinically significant hospital‐level variation as a difference of more than 10% between observed and expected outcomes. We next examined the association between hospital‐level spending and mortality rate, adjusting for hospital characteristics, such as local wage index and percentage of low‐income patients. Finally, we divided hospitals into quintiles of spendirig and, using a 1‐way analysis of variance, examined the adjusted mortality rate across quintiles and stratified by teaching status.

Results:

Included in the study were 166,931 patients from 309 hospitals, of whom 33,192 (20%) died in the hospital. We observed wide variations in both hospital‐level mortality and cost. Among the 56 hospitals with expected mortality between 18.5% to 19.5%, observed mortality ranged from 9% to 27%. Seventy hospitals (23%) exceeded expected costs by at least 10%, with a median average excess cost per case of $5164. Overall, 41 hospitals (13% had both lower than expected) costs and mortality rates, and 24 hospitals (8%) had both higher than expected costs and mortality rates (Fig. 1). In a fully adjusted model, we did not find a significant association between hospital spending and mortality. Additionally, there was no consistent trend between cost and mortality across quintiles of spending or teaching status (Fig. 2), although the highest spending quintile had higher mortality rates than the other 4(P = 0.007).

Conclusions:

Hospital spending and adjusted mortality rates for patients with sepsis vary substantially, but higher hospital expenditures might not associated with lower mortality. Efforts to enhance the value of sepsis care could be guided by studying the practices of hospitals that achieve consistently lower than expected mortality and costs.

Author Disclosure:

T. Lagu, none; M. Rothberg, none; B. Nathanson, none; P. Pekow, none; J. Steingrub, Baystate Medical Center/Tufts University School of Medicine, grant support and lecture bureau for Eli Lilly & Company; P. Lindenauer, none.

To cite this abstract:

Lagu T, Rothberg M, Nathanson B, Pekow P, grub J, Lindenauer P. Higher Hospital Spending Does Not Result in Lower Adjusted Mortality in Sepsis. Abstract published at Hospital Medicine 2010, April 8-11, Washington, D.C. Abstract 84. Journal of Hospital Medicine. 2010; 5 (suppl 1). https://www.shmabstracts.com/abstract/higher-hospital-spending-does-not-result-in-lower-adjusted-mortality-in-sepsis/. Accessed September 15, 2019.

« Back to Hospital Medicine 2010, April 8-11, Washington, D.C.