Post-Acute Care Use and Hospital Readmission after Sepsis.
BACKGROUND
The epidemiology of post-acute care use and hospital readmission after sepsis remains largely unknown.


OBJECTIVE
To examine the rate of post-acute care use and hospital readmission after sepsis and to examine risk factors and outcomes for hospital readmissions after sepsis.


METHODS
In an observational cohort study conducted in an academic health care system (2010-2012), we compared post-acute care use at discharge and hospital readmission after 3,620 sepsis hospitalizations with 108,958 nonsepsis hospitalizations. We used three validated, claims-based approaches to identify sepsis and severe sepsis.


RESULTS
Post-acute care use at discharge was more likely after sepsis, driven by skilled care facility placement (35.4% after sepsis vs. 15.8%; P < 0.001), with the highest rate observed after severe sepsis. Readmission rates at 7, 30, and 90 days were higher postsepsis (P < 0.001). Compared with nonsepsis hospitalizations (15.6% readmitted within 30 d), the increased readmission risk was present regardless of sepsis severity (27.3% after sepsis and 26.0-26.2% after severe sepsis). After controlling for presepsis characteristics, the readmission risk was found to be 1.51 times greater (95% CI, 1.38-1.66) than nonsepsis hospitalizations. Readmissions after sepsis were more likely to result in death or transition to hospice care (6.1% vs. 13.3% after sepsis; P < 0.001). Independent risk factors associated with 30-day readmissions after sepsis hospitalizations included age, malignancy diagnosis, hospitalizations in the year prior to the index hospitalization, nonelective index admission type, one or more procedures during the index hospitalization, and low hemoglobin and high red cell distribution width at discharge.


CONCLUSIONS
Post-acute care use and hospital readmissions were common after sepsis. The increased readmission risk after sepsis was observed regardless of sepsis severity and was associated with adverse readmission outcomes.
1 Department of Medicine.|2 Division of Pulmonary, Allergy, and Critical Care.
Tiffanie K
TK
Jones
1 Department of Medicine.|2 Division of Pulmonary, Allergy, and Critical Care.
Barry D
BD
Fuchs
3 The Wharton School.|4 Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania; and.
Dylan S
DS
Small
1 Department of Medicine.|2 Division of Pulmonary, Allergy, and Critical Care.|5 Center for Clinical Epidemiology and Biostatistics.|6 Department of Medical Ethics and Health Policy.|4 Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania; and.
Scott D
SD
Halpern
7 Office of the Chief Medical Officer, University of Pennsylvania Health System, Philadelphia, Pennsylvania.
Asaf
A
Hanish
1 Department of Medicine.|5 Center for Clinical Epidemiology and Biostatistics.|4 Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania; and.|7 Office of the Chief Medical Officer, University of Pennsylvania Health System, Philadelphia, Pennsylvania.
Craig A
CA
Umscheid
5 Center for Clinical Epidemiology and Biostatistics.
Charles A
CA
Baillie
1 Department of Medicine.|2 Division of Pulmonary, Allergy, and Critical Care.|5 Center for Clinical Epidemiology and Biostatistics.|4 Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania; and.
Meeta Prasad
MP
Kerlin
8 Department of Emergency Medicine, Perelman School of Medicine.
David F
DF
Gaieski
1 Department of Medicine.|2 Division of Pulmonary, Allergy, and Critical Care.|5 Center for Clinical Epidemiology and Biostatistics.
Mark E
ME
Mikkelsen
D000328:Adult; D000367:Age Factors; D000368:Aged; D003422:Critical Care / Q000379:methods / Q000706:statistics & numerical data; D004909:Erythrocyte Indices; D005260:Female; D006454:Hemoglobins / Q000032:analysis; D006801:Humans; D007345:Insurance Claim Review / Q000706:statistics & numerical data; D008297:Male; D006278:Medicare / Q000706:statistics & numerical data; D008875:Middle Aged; D009369:Neoplasms / Q000175:diagnosis; D010351:Patient Discharge / Q000706:statistics & numerical data*; D010359:Patient Readmission / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods; D012307:Risk Factors; D018805:Sepsis / Q000453:epidemiology / Q000628:therapy; D014481:United States / Q000453:epidemiology
D006454:Hemoglobins
critical care; emergency department use; hospital readmission; infection; sepsis