Transitional care after hospitalization for sepsis in Germany- results from the population-based AVENIR cohort study.

Abstract

Purpose: Sepsis survivorship is associated with significant long-term morbidity, mortality and health care utilization. Transitional care between inpatient and follow-up care is crucial, but insufficiently understood. We investigated health care utilization in sepsis survivors 90 days post-discharge, comparing translational care during 2016-2019 vs. 2020 in the first year of the pandemic.

Methods: This retrospective cohort study used nationwide health claims data of the "AOK- die Gesundheitskasse". Sepsis patients with inpatient treatment in 2016-2019 were identified using explicit ICD-10 codes for sepsis and codes for organ dysfunction. A second sepsis patient cohort was identified in 2020, which included also explicitly defined sepsis patients as well as patients with COVID-19 and Influenza with evidence of organ dysfunction. Among survivors, health care utilization in the 90 days post-discharge was assessed and first health service provider contacts were visualized using Sankey diagrams.

Results: Among 234,874 sepsis survivors in 2016-2019, 94.4% were treated by a general practitioner, 47.7% had ≥ 1 hospital readmission and 42.8% of patients had ≥ 1 emergency treatment 90 days post-sepsis. Nearly all patients had prompt health service provider contacts in that time frame, with physicians in the outpatient sector being the most common first and second health service provider contacts. In the 2020 cohort (n = 69,432 survivors), more patients died without follow-up contact. Additionally, the latency to the first and second health service provider contacts were elevated compared to 2016-2019.

Discussion: Sepsis survivors receive early, high-frequency follow-up care in the inpatient and outpatient sector. This may be an opportunity to implement early screening for sequelae and targeted therapies.