Healthcare Use and Expenditures in Rural Survivors of Hospitalization for Sepsis.

IF 7.7 1区 医学 Q1 CRITICAL CARE MEDICINE
Critical Care Medicine Pub Date : 2024-11-01 Epub Date: 2024-08-13 DOI:10.1097/CCM.0000000000006397
Kyle R Stinehart, J Madison Hyer, Shivam Joshi, Nathan E Brummel
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引用次数: 0

Abstract

Objectives: Sepsis survivors have greater healthcare use than those surviving hospitalizations for other reasons, yet factors associated with greater healthcare use in this population remain ill-defined. Rural Americans are older, have more chronic illnesses, and face unique barriers to healthcare access, which could affect postsepsis healthcare use. Therefore, we compared healthcare use and expenditures among rural and urban sepsis survivors. We hypothesized that rural survivors would have greater healthcare use and expenditures.

Design, setting, and patients: To test this hypothesis, we used data from 106,189 adult survivors of a sepsis hospitalization included in the IBM MarketScan Commercial Claims and Encounters database and Medicare Supplemental database between 2013 and 2018.

Interventions: None.

Measurements and main results: We identified hospitalizations for severe sepsis and septic shock using the International Classification of Diseases , 9th Edition (ICD-9) or 1CD-10 codes. We used Metropolitan Statistical Area classifications to categorize rurality. We measured emergency department (ED) visits, inpatient hospitalizations, skilled nursing facility admissions, primary care visits, physical therapy visits, occupational therapy visits, and home healthcare visits for the year following sepsis hospitalizations. We calculated the total expenditures for each of these categories. We compared outcomes between rural and urban patients using multivariable regression and adjusted for covariates. After adjusting for age, sex, comorbidities, admission type, insurance type, U.S. Census Bureau region, employment status, and sepsis severity, those living in rural areas had 17% greater odds of having an ED visit (odds ratio [OR] 1.17; 95% CI, 1.13-1.22; p < 0.001), 9% lower odds of having a primary care visit (OR 0.91; 95% CI, 0.87-0.94; p < 0.001), and 12% lower odds of receiving home healthcare (OR 0.88; 95% CI, 0.84-0.93; p < 0.001). Despite higher levels of ED use and equivalent levels of hospital readmissions, expenditures in these areas were 14% (OR 0.86; 95% CI, 0.80-0.91; p < 0.001) and 9% (OR 0.91; 95% CI, 0.87-0.96; p < 0.001) lower among rural survivors, respectively, suggesting these services may be used for lower-acuity conditions.

Conclusions: In this large cohort study, we report important differences in healthcare use and expenditures between rural and urban sepsis survivors. Future research and policy work is needed to understand how best to optimize sepsis survivorship across the urban-rural continuum.

因败血症住院的农村幸存者的医疗保健使用和支出。
目的:与因其他原因住院的幸存者相比,败血症幸存者的医疗保健使用率更高,但与该人群医疗保健使用率更高相关的因素仍不明确。美国农村人口年龄较大,慢性病较多,在获得医疗服务方面面临独特的障碍,这可能会影响败血症后医疗服务的使用。因此,我们比较了农村和城市败血症幸存者的医疗保健使用情况和支出。我们假设,农村幸存者的医疗保健使用率和支出会更高:为了验证这一假设,我们使用了2013年至2018年期间IBM MarketScan商业索赔和遭遇数据库以及医疗保险补充数据库中106189名脓毒症住院成年幸存者的数据:无:我们使用国际疾病分类第 9 版 (ICD-9) 或 1CD-10 编码确定了严重败血症和脓毒性休克的住院情况。我们使用大都市统计区分类法对乡村地区进行分类。我们对脓毒症患者住院后一年内的急诊科(ED)就诊、住院、专业护理机构入院、初级保健就诊、物理治疗就诊、职业治疗就诊和家庭保健就诊进行了测量。我们计算了每个类别的总支出。我们使用多变量回归法比较了农村和城市患者的治疗结果,并对协变量进行了调整。在对年龄、性别、合并症、入院类型、保险类型、美国人口普查局地区、就业状况和败血症严重程度进行调整后,居住在农村地区的患者到急诊室就诊的几率比城市患者高出 17%(几率比 [OR] 1.17;95% CI,1.13-1.22;p < 0.001),初级保健就诊几率低 9%(OR 0.91;95% CI,0.87-0.94;p < 0.001),接受家庭保健的几率低 12%(OR 0.88;95% CI,0.84-0.93;p < 0.001)。尽管急诊室使用率和再入院率较高,但这些地区的支出在农村幸存者中分别降低了 14% (OR 0.86; 95% CI, 0.80-0.91; p < 0.001) 和 9% (OR 0.91; 95% CI, 0.87-0.96; p < 0.001),这表明这些服务可能用于急性程度较低的病症:在这项大型队列研究中,我们报告了农村和城市败血症幸存者在医疗保健使用和支出方面的重要差异。未来需要开展研究和制定政策,以了解如何在城乡之间优化败血症幸存者的医疗服务。
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来源期刊
Critical Care Medicine
Critical Care Medicine 医学-危重病医学
CiteScore
16.30
自引率
5.70%
发文量
728
审稿时长
2 months
期刊介绍: Critical Care Medicine is the premier peer-reviewed, scientific publication in critical care medicine. Directed to those specialists who treat patients in the ICU and CCU, including chest physicians, surgeons, pediatricians, pharmacists/pharmacologists, anesthesiologists, critical care nurses, and other healthcare professionals, Critical Care Medicine covers all aspects of acute and emergency care for the critically ill or injured patient. Each issue presents critical care practitioners with clinical breakthroughs that lead to better patient care, the latest news on promising research, and advances in equipment and techniques.
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