title: Increased 1-year healthcare use in survivors of severe sepsis.
abstract: BACKGROUND
  Hospitalizations for severe sepsis are common, and a growing number of patients survive to hospital discharge. Nonetheless, little is known about survivors' post-discharge healthcare use.
  
  
  OBJECTIVE
  To measure inpatient healthcare use of severe sepsis survivors compared with patients' own presepsis resource use and the resource use of survivors of otherwise similar nonsepsis hospitalizations.
  
  
  METHODS
  This is an observational cohort study of survivors of severe sepsis and nonsepsis hospitalizations identified from participants in the Health and Retirement Study with linked Medicare claims, 1998-2005. We matched severe sepsis and nonsepsis hospitalizations by demographics, comorbidity burden, premorbid disability, hospitalization length, and intensive care use.
  
  
  RESULTS
  Using Medicare claims, we measured patients' use of inpatient facilities (hospitals, long-term acute care hospitals, and skilled nursing facilities) in the 2 years surrounding hospitalization. Severe sepsis survivors spent more days (median, 16 [interquartile range, 3-45] vs. 7 [0-29]; P < 0.001) and a higher proportion of days alive (median, 9.6% [interquartile range, 1.4-33.8%] vs. 1.9% [0.0-7.9%]; P < 0.001) admitted to facilities in the year after hospitalization, compared with the year prior. The increase in facility-days was similar for nonsepsis hospitalizations. However, the severe sepsis cohort experienced greater post-discharge mortality (44.2% [95% confidence interval, 41.3-47.2%] vs. 31.4% [95% confidence interval, 28.6-34.2%] at 1 year), a steeper decline in days spent at home (difference-in-differences, -38.6 d [95% confidence interval, -50.9 to 26.3]; P < 0.001), and a greater increase in the proportion of days alive spent in a facility (difference-in-differences, 5.4% [95% confidence interval, 2.8-8.1%]; P < 0.001).
  
  
  CONCLUSIONS
  Healthcare use is markedly elevated after severe sepsis, and post-discharge management may be an opportunity to reduce resource use.
authors.affiliation: 1 Department of Medicine, University of Michigan, Ann Arbor, Michigan.
authors.forename: Hallie C
authors.initials: HC
authors.lastname: Prescott
authors.forename: Kenneth M
authors.initials: KM
authors.lastname: Langa
authors.forename: Vincent
authors.initials: V
authors.lastname: Liu
authors.forename: Gabriel J
authors.initials: GJ
authors.lastname: Escobar
authors.forename: Theodore J
authors.initials: TJ
authors.lastname: Iwashyna
mesh_terms: D000368:Aged; D005260:Female; D006268:Health Facilities / Q000706:statistics & numerical data*; D006801:Humans; D007345:Insurance Claim Review / Q000706:statistics & numerical data; D008134:Long-Term Care / Q000706:statistics & numerical data; D008297:Male; D008498:Medical Record Linkage; D006278:Medicare / Q000706:statistics & numerical data; D009026:Mortality / Q000639:trends; D017063:Outcome Assessment, Health Care / Q000706:statistics & numerical data*; D010359:Patient Readmission / Q000706:statistics & numerical data; D011446:Prospective Studies; D018805:Sepsis / Q000150:complications* / Q000453:epidemiology; D012866:Skilled Nursing Facilities / Q000706:statistics & numerical data; D017741:Survivors / Q000706:statistics & numerical data*; D014481:United States / Q000453:epidemiology
keywords: healthcare facilities; hospitalization; patient outcomes assessment; patient readmission; skilled nursing facility