Sepsis metrics unfairly ding safety-net hospitals, study suggests

State and federal quality metrics that focus on in-hospital mortality for sepsis patients may unfairly penalize safety-net hospitals, according to a study published May 31 in JAMA Network Open.

Past studies have shown safety-net hospitals have higher rates of in-hospital mortality among sepsis patients compared to other hospitals. However, the new study suggests these disparities may be based on differences in discharge practices, as safety nets may have less ability to transfer patients to hospice settings. 

A team led by researchers at the Boston University School of Medicine conducted the latest study, which examined Medicare data on more than 2 million sepsis patients ages 66 and older admitted to intensive care units nationwide between 2011 and 2019. 

Admission to a safety-net hospital was associated with a higher in-hospital mortality, but not 30-day mortality rate, researchers found. Patients admitted to safety nets were also less likely to be discharged to hospice.

"Differences in in-hospital mortality may partially be explained by greater use of hospice at non–safety-net hospitals, which shifts attribution of death from the index hospitalization to hospice," researchers concluded. "Future investigations and publicly reported quality measures should consider time-delimited rather than hospital-delimited measures of short-term mortality to avoid undue penalty to safety-net hospitals with similar short-term mortality."

Read the full study here.

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