{"id":26229,"date":"2024-09-18T04:06:00","date_gmt":"2024-09-17T20:06:00","guid":{"rendered":"http:\/\/csccm.org.cn\/?p=26229"},"modified":"2024-09-18T05:38:08","modified_gmt":"2024-09-17T21:38:08","slug":"icu-management-practice-%e4%bd%8f%e9%99%a2%e7%97%85%e6%ad%bb%e7%8e%87%e4%bd%9c%e4%b8%ba%e8%84%93%e6%af%92%e7%97%87%e5%8c%bb%e7%96%97%e8%b4%a8%e9%87%8f%e6%8e%a7%e5%88%b6%e6%8c%87%e6%a0%87","status":"publish","type":"post","link":"https:\/\/csccm.org.cn\/?p=26229","title":{"rendered":"[ICU Management &#038; Practice]: \u4f4f\u9662\u75c5\u6b7b\u7387\u4f5c\u4e3a\u8113\u6bd2\u75c7\u533b\u7597\u8d28\u91cf\u63a7\u5236\u6307\u6807"},"content":{"rendered":"\n<h1 class=\"wp-block-heading\">In-Hospital Mortality as a Sepsis Quality Metric<\/h1>\n\n\n\n<ul>\n<li>In&nbsp;<a href=\"https:\/\/healthmanagement.org\/c\/sepsis\">Sepsis<\/a><\/li>\n\n\n\n<li>Sat, 1 Jun 2024<\/li>\n<\/ul>\n\n\n\n<figure class=\"wp-block-image size-large\"><img decoding=\"async\" src=\"https:\/\/res.cloudinary.com\/healthmanagement-org\/image\/upload\/c_thumb,f_auto,fl_lossy,h_700,q_90,w_1000\/v1717239455\/cw\/00127380_cw_image_wi_b7de5d076871a4d34fbff5cd746eec13.webp\" alt=\"\"\/><\/figure>\n\n\n\n<p>Sepsis is a major cause of death and disability and a key focus of quality measures for hospitals. In-hospital mortality of sepsis patients is often used for benchmarking by researchers and policymakers. For instance, in New York, sepsis regulations require reporting risk-adjusted in-hospital mortality, identifying hospitals with higher or lower than expected rates as high or low performers. Prior studies have shown that safety-net hospitals face unique challenges, including limited resources and a high share of underinsured and high-risk patients. They tend to have higher risk-adjusted in-hospital mortality rates for sepsis patients compared to non-safety-net hospitals.<\/p>\n\n\n\n<p>However, for critically ill patients, in-hospital mortality might not accurately reflect short-term mortality across all hospitals due to variables like hospital transfer practices that shift the attribution of short-term deaths to other sites. Safety-net hospitals may have different capabilities for patient transfers compared to non-safety-net hospitals.<\/p>\n\n\n\n<p>A new study by researchers at Boston University Chobanian &amp; Avedisian School of Medicine found that although safety-net hospitals have higher in-hospital mortality rates than non-safety-net hospitals, their 30-day mortality rates, which provide an unbiased measure of short-term mortality, are not significantly different. These findings are published in JAMA Network Open.<\/p>\n\n\n\n<p>Study researchers explain that while the differences in mortality rates are numerically small, they significantly affect hospital rankings. Current or future state and federal quality measures using in-hospital mortality as a quality metric may unfairly penalise safety-net hospitals.&nbsp;<\/p>\n\n\n\n<p>The researchers conducted a retrospective analysis of sepsis patients aged 66 and older admitted to an intensive care unit between January 1, 2011, and December 31, 2019, at both safety-net and non-safety-net hospitals.<\/p>\n\n\n\n<p>In-hospital mortality is often used as an outcome measure due to its availability in claims databases and hospital records without needing post-hospitalisation follow-up. However, the 30-day mortality measure is crucial for accurately understanding true short-term mortality rates.&nbsp;<\/p>\n\n\n\n<p>The researchers noted that non-safety-net hospitals discharge more patients to hospice, which shifts the attribution of short-term mortality away from the index hospitalisation. When post-hospitalisation data is included, as in 30-day mortality analysis, it provides a more accurate picture of short-term mortality, showing no significant difference between safety-net and non-safety-net hospitals, explain the researchers. The Centers for Medicare and Medicaid Services (CMS) has implemented a process measure to assess whether hospitals efficiently perform key sepsis care steps, such as initiating antibiotics. CMS is considering a national sepsis outcome measure, but it is not yet known whether it will measure in-hospital or 30-day mortality.<\/p>\n\n\n\n<p>Source:&nbsp;<a href=\"https:\/\/www.bumc.bu.edu\/camed\/2024\/05\/31\/study-finds-policy-makers-use-of-in-hospital-mortality-as-a-sepsis-quality-metric-may-unfairly-penalize-safety-net-hospitals\/\" target=\"_blank\" rel=\"noreferrer noopener\">Boston University School of Medicine<\/a><br \/>Image Credit: iStock&nbsp;<\/p>\n\n\n\n<h4 class=\"wp-block-heading\">References:<\/h4>\n\n\n\n<p>Law AC,&nbsp;Bosch NA,&nbsp;Song Y et al. (2024) I<a href=\"https:\/\/jamanetwork.com\/journals\/jamanetworkopen\/fullarticle\/2819342\" target=\"_blank\" rel=\"noreferrer noopener\">n-Hospital vs 30-Day Sepsis Mortality at US Safety-Net and Non\u2013Safety-Net Hospitals.<\/a>&nbsp;JAMA Netw Open.&nbsp;7(5):e2412873.<\/p>\n","protected":false},"excerpt":{"rendered":"<p>In-Hospital Mortality as a Sepsis Quality Metric Sepsis [&hellip;]<\/p>\n","protected":false},"author":3,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":[],"categories":[24,23],"tags":[],"_links":{"self":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/26229"}],"collection":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/users\/3"}],"replies":[{"embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=26229"}],"version-history":[{"count":1,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/26229\/revisions"}],"predecessor-version":[{"id":26230,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/26229\/revisions\/26230"}],"wp:attachment":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=26229"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=26229"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=26229"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}