Sepsis patients return to hospital for preventable reasons; better post care needed

Better post-hospital care is needed for sepsis patients to avoid readmissions that drive up costs and interfere with recovery, according to a study published in the March 10 issue of JAMA.

Hospital readmission is common among patients who survive severe sepsis. Among a nationally representative sample of older Americans with a hospitalization for severe sepsis, 42% end up back in the hospital in the next 3 months.

This rate of hospital readmission is similar to that seen in patients who survive other acute medical conditions, according to Hallie Prescott, MD, MSc, lead author and a critical care physician at the University of Michigan Health System.

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However, the reasons for hospital readmission are different after sepsis; 42% of hospital readmissions among sepsis survivors are for “ambulatory-care sensitive conditions”-conditions that can potentially be prevented or treated early in the outpatient setting to avoid hospitalization. For these, the care provided at physician’s visits can make a major difference in how well the patient does overall, and how well they avoid the hospital. Furthermore, just 10 diagnoses accounted for over half of all readmissions in the sepsis patients.

Dr Prescott

“These findings suggest that tools to calculate patients’ personalized risks for different types of hospital readmissions and good primary care may be able to reduce healthcare utilization,” said Dr Prescott.

Dr Prescott and colleagues studied a nationally representative sample of older Americans (Health and Retirement Study). They used Medicare claims to identify patients hospitalized with severe sepsis and other acute medical conditions from 1998 to 2010. Patients were matched with severe sepsis and other acute medical conditions 1:1 by age, sex, comorbidity burden, functional status, and hospital length of stay.

“We next measured the rate of hospital readmission in the 90 days following initial hospital discharge for sepsis or other acute medical conditions,” Dr Prescott explained. “We also examined the primary readmission diagnoses and measured the proportions that were for ambulatory-care sensitive conditions.”

Because of Medicare’s financial penalties to hospitals with greater than expected hospital readmissions after pneumonia, heart attack, and heart failure, much of the debate focuses on the hospital’s role in preventing readmission, according to Dr Prescott.

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“However, this study suggests that many of the conditions that bring people back to the hospital are potentially preventable with better outpatient care,” she said. “Thus, we need to design better systems to support patients in the weeks to months that follow hospital discharge. Hospital readmissions are common after severe sepsis, and many of the re-hospitalizations may be preventable.

“A handful of potentially preventable conditions account for many of the hospital readmissions,” Dr Prescott continued. “Personalizing post-discharge care to patients’ risk for these outcomes may be feasible and beneficial.”

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