High-cost users after sepsis: a population-based observational cohort study

IF 8.8 1区医学 Q1 CRITICAL CARE MEDICINE

Critical Care Pub Date : 2024-10-21 DOI:10.1186/s13054-024-05108-6

Kali A. Barrett, Fatima Sheikh, Victoria Chechulina, Hannah Chung, Peter Dodek, Laura Rosella, Kednapa Thavorn, Damon C. Scales

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引用次数: 0

Abstract

High-cost users (HCU) represent important targets for health policy interventions. Sepsis is a life-threatening syndrome that is associated with high morbidity, mortality, and economic costs to the healthcare system. We sought to estimate the effect of sepsis on being a subsequent HCU. Using linked health-administrative databases, we conducted a population-based, propensity score-weighted cohort study of adults who survived a hospitalization in Ontario, Canada between January 2016 and December 2017. Sepsis was identified using a validated algorithm. The primary outcome was being a persistent HCU after hospital discharge (in the top 5% or 1% of total health care spending for 90 consecutive days), and the proportion of follow-up time since discharge as a HCU. We identified 927,057 hospitalized individuals, of whom 79,065 had sepsis. Individuals who had sepsis were more likely to be a top 5% HCU for 90 consecutive days at any time after discharge compared to those without sepsis (OR 2.24; 95% confidence interval [CI] 2.04–2.46) and spent on average 42.3% of their follow up time as a top 5% HCU compared to 28.9% of time among those without sepsis (RR 1.46; 95% CI 1.45–1.48). Individuals with sepsis were more likely to be a top 1% HCU for 90 consecutive days compared to those without sepsis (10% versus 5.1%, OR 2.05 [95% CI 1.99–2.11]), and spent more time as a top 1% HCU (18.5% of time versus 10.8% of time, RR 1.68 [95% CI 1.65–1.70]). The sequelae of sepsis result in higher healthcare costs with important economic implications. After discharge, individuals who experienced sepsis are more likely to be a HCU and spend more time as a HCU compared to individuals who did not experience sepsis during hospitalization.

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败血症后的高成本用户：基于人群的观察性队列研究

高成本用户（HCU）是卫生政策干预的重要目标。败血症是一种危及生命的综合征，与高发病率、高死亡率和医疗保健系统的高经济成本相关。我们试图估算脓毒症对后续成为 HCU 的影响。我们利用关联的卫生行政数据库，对 2016 年 1 月至 2017 年 12 月期间在加拿大安大略省住院治疗的成人进行了一项基于人群的倾向得分加权队列研究。脓毒症是通过一种经过验证的算法确定的。研究的主要结果是出院后是否持续成为重症监护病房（连续 90 天在医疗保健总支出中排名前 5%或 1%），以及出院后作为重症监护病房的随访时间比例。我们确定了 927,057 名住院患者，其中 79,065 人患有败血症。与未患败血症的患者相比，患败血症的患者更有可能在出院后连续 90 天内的任何时间成为前 5%的重症监护病房（OR 2.24；95% 置信区间 [CI] 2.04-2.46），平均 42.3% 的随访时间为前 5%的重症监护病房，而未患败血症的患者为 28.9%（RR 1.46；95% CI 1.45-1.48）。与未患败血症的患者相比，患败血症的患者更有可能连续 90 天成为前 1%重症监护病房（10% 对 5.1%，OR 2.05 [95% CI 1.99-2.11]），而且成为前 1%重症监护病房的时间更长（18.5% 对 10.8%，RR 1.68 [95% CI 1.65-1.70]）。败血症的后遗症导致医疗成本增加，对经济产生重要影响。出院后，与住院期间未患脓毒症的患者相比，患脓毒症的患者更有可能成为重症监护病房（HCU），且在重症监护病房的住院时间更长。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Critical Care 医学-危重病医学

CiteScore

20.60

自引率

3.30%

发文量

348

审稿时长

1.5 months

期刊介绍： Critical Care is an esteemed international medical journal that undergoes a rigorous peer-review process to maintain its high quality standards. Its primary objective is to enhance the healthcare services offered to critically ill patients. To achieve this, the journal focuses on gathering, exchanging, disseminating, and endorsing evidence-based information that is highly relevant to intensivists. By doing so, Critical Care seeks to provide a thorough and inclusive examination of the intensive care field.