ArticleCritical care medicine2018
Mortality Measures to Profile Hospital Performance for Patients With Septic Shock.
Article in Critical care medicine, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 14 papers, 1 of them a synthesis that pooled it.
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14 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Sepsis prediction, early detection, and identification using clinical text for machine learning: a systematic review.Journal of the American Medical Informatics Association : JAMIA · 2022Pooled it
- Article
- Accounting for clustering in automated variable selection using hospital data: a comparison of different LASSO approaches.BMC medical research methodology · 2023Article
- Intravenous to Oral Antibiotic Switch Therapy Among Patients Hospitalized With Community-Acquired Pneumonia.Clinical infectious diseases : an official publication of the Infectious Diseases Society of America · 2023Article
- Development and validation of risk-adjusted quality indicators for the long-term outcome of acute sepsis care in German hospitals based on health claims data.Frontiers in medicine · 2022Article
- Surveillance Strategies for Tracking Sepsis Incidence and Outcomes.The Journal of infectious diseases · 2020Review
- U.S. hospital performance methodologies: a scoping review to identify opportunities for crossing the quality chasm.BMC health services research · 2020Article
- Impact of Risk Adjustment Using Clinical vs Administrative Data on Hospital Sepsis Mortality Comparisons.Open forum infectious diseases · 2020Article
- Patient Outcomes and Cost-Effectiveness of a Sepsis Care Quality Improvement Program in a Health System.Critical care medicine · 2019Observational
- Risk Adjustment for Sepsis Mortality to Facilitate Hospital Comparisons Using Centers for Disease Control and Prevention's Adult Sepsis Event Criteria and Routine Electronic Clinical Data.Critical care explorations · 2019Article
- An administrative model for benchmarking hospitals on their 30-day sepsis mortality.BMC health services research · 2019Article
- Variation in Identifying Sepsis and Organ Dysfunction Using Administrative Versus Electronic Clinical Data and Impact on Hospital Outcome Comparisons.Critical care medicine · 2019Article
- Exploring the Pathways Revealed by International Sepsis Benchmarking.Critical care medicine · 2019Article
- Article
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Abstract
objectivesSepsis care is becoming a more common target for hospital performance measurement, but few studies have evaluated the acceptability of sepsis or septic shock mortality as a potential performance measure. In the absence of a gold standard to identify septic shock in claims data, we assessed agreement and stability of hospital mortality performance under different case definitions.
designRetrospective cohort study.
settingU.S. acute care hospitals. PATIENTS: Hospitalized with septic shock at admission, identified by either implicit diagnosis criteria (charges for antibiotics, cultures, and vasopressors) or by explicit International Classification of Diseases, 9th revision, codes.
interventionsNone. MEASUREMENTS AND MAIN
resultsWe used hierarchical logistic regression models to determine hospital risk-standardized mortality rates and hospital performance outliers. We assessed agreement in hospital mortality rankings when septic shock cases were identified by either explicit International Classification of Diseases, 9th revision, codes or implicit diagnosis criteria. Kappa statistics and intraclass correlation coefficients were used to assess agreement in hospital risk-standardized mortality and hospital outlier status, respectively. Fifty-six thousand six-hundred seventy-three patients in 308 hospitals fulfilled at least one case definition for septic shock, whereas 19,136 (33.8%) met both the explicit International Classification of Diseases, 9th revision, and implicit septic shock definition. Hospitals varied widely in risk-standardized septic shock mortality (interquartile range of implicit diagnosis mortality: 25.4-33.5%; International Classification of Diseases, 9th revision, diagnosis: 30.2-38.0%). The median absolute difference in hospital ranking between septic shock cohorts defined by International Classification of Diseases, 9th revision, versus implicit criteria was 37 places (interquartile range, 16-70), with an intraclass correlation coefficient of 0.72, p value of less than 0.001; agreement between case definitions for identification of outlier hospitals was moderate (kappa, 0.44 [95% CI, 0.30-0.58]).
conclusionsRisk-standardized septic shock mortality rates varied considerably between hospitals, suggesting that septic shock is an important performance target. However, efforts to profile hospital performance were sensitive to septic shock case definitions, suggesting that septic shock mortality is not currently ready for widespread use as a hospital quality measure.
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