title: Severe sepsis: variation in resource and therapeutic modality use among academic centers.
abstract: BACKGROUND
  Treatment of severe sepsis is expensive, often encompassing a number of discretionary modalities. The objective of the present study was to assess intercenter variation in resource and therapeutic modality use in patients with severe sepsis.
  
  
  METHODS
  We conducted a prospective cohort study of 1028 adult admissions with severe sepsis from a stratified random sample of patients admitted to eight academic tertiary care centers. The main outcome measures were length of stay (LOS; total LOS and LOS after onset of severe sepsis) and total hospital charges.
  
  
  RESULTS
  The adjusted mean total hospital charges varied from 69 429 dollars to US237 898 dollars across centers, whereas the adjusted LOS after onset varied from 15.9 days to 24.2 days per admission. Treatments used frequently after the first onset of sepsis among patients with severe sepsis were pulmonary artery catheters (19.4%), ventilator support (21.8%), pressor support (45.8%) and albumin infusion (14.4%). Pulmonary artery catheter use, ventilator support and albumin infusion had moderate variation profiles, varying 3.2-fold to 4.9-fold, whereas the rate of pressor support varied only 1.92-fold across centers. Even after adjusting for age, sex, Charlson comorbidity score, discharge diagnosis-relative group weight, organ dysfunction and service at onset, the odds for using these therapeutic modalities still varied significantly across centers. Failure to start antibiotics within 24 hours was strongly correlated with a higher probability of 28-day mortality (r2 = 0.72).
  
  
  CONCLUSIONS
  These data demonstrate moderate but significant variation in resource use and use of technologies in treatment of severe sepsis among academic centers. Delay in antibiotic therapy was associated with worse outcome at the center level.
authors.affiliation: Brigham and Women's Hospital, Partners HealthCare System, Wellesley, Massachusetts, USA.
authors.forename: D Tony
authors.initials: DT
authors.lastname: Yu
authors.forename: Edgar
authors.initials: E
authors.lastname: Black
authors.forename: Kenneth E
authors.initials: KE
authors.lastname: Sands
authors.forename: J Sanford
authors.initials: JS
authors.lastname: Schwartz
authors.forename: Patricia L
authors.initials: PL
authors.lastname: Hibberd
authors.forename: Paul S
authors.initials: PS
authors.lastname: Graman
authors.forename: Paul N
authors.initials: PN
authors.lastname: Lanken
authors.forename: Katherine L
authors.initials: KL
authors.lastname: Kahn
authors.forename: David R
authors.initials: DR
authors.lastname: Snydman
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Parsonnet
authors.forename: Richard
authors.initials: R
authors.lastname: Moore
authors.forename: Richard
authors.initials: R
authors.lastname: Platt
authors.forename: David W
authors.initials: DW
authors.lastname: Bates
mesh_terms: D000046:Academic Medical Centers / Q000191:economics / Q000706:statistics & numerical data*; D015331:Cohort Studies; D005260:Female; D017722:Hospital Charges; D006801:Humans; D007362:Intensive Care Units / Q000191:economics / Q000706:statistics & numerical data; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D010043:Outcome and Process Assessment, Health Care; D010818:Practice Patterns, Physicians' / Q000191:economics / Q000706:statistics & numerical data*; D011446:Prospective Studies; D011897:Random Allocation; D018805:Sepsis / Q000191:economics / Q000453:epidemiology / Q000628:therapy*; D014481:United States / Q000453:epidemiology