Header: AHRQ has released a Report to Congress on Sepsis, as well as supporting a bundle of new hospital policy articles on the topic.
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About the last time I mentioned AHRQ, the House had proposed to de-fund it in July 2024.
Flurry of news from AHRQ about Sepsis, including a 95-page new Congressional report.
- See the AHRQ capsule news page here.
- See the full press release and links here.
- See the 95 page report here.
- See 166 page appendix here.
- See the AHRQ home page for Sepsis, here.
- See AHRQ highlight three new hospital policy articles:
- Sankaran (2024) Identifying sources of inter hospital variation in episode spending for hospital care. Med Care 62:441.
- Barbash (2024) Association between SEP-1 and documentation of sepsis in the clinical record. Med Care 62:388.
- Ellenbogen (2024) Developent of a hospital coding intensity measure for sepsis. J Hosp Med 19:505.
- These three articles don't appear to be open access.
The report responds to a congressional directive included in the Fiscal Year 2023 Omnibus Spending Bill, which mandated AHRQ to study morbidity, readmission, and mortality rates associated with sepsis, along with the effects of the COVID-19 pandemic on the burden of sepsis.
Key findings of the report show that sepsis-related hospitalizations increased sharply from 1.8 million in 2016 to 2.5 million in 2021, a trend accelerated by the COVID-19 pandemic. Sepsis is one of the most expensive conditions treated in U.S. hospitals, with aggregate hospital costs rising from $31.2 billion to $52.1 billion over the same period. The report provides an in-depth look at hospital utilization, mortality, and the financial strain caused by sepsis, with a focus on disparities in outcomes based on race, ethnicity, sex, geographic location, and social vulnerability.
The report also highlights key patient populations affected by sepsis, including non-maternal adults, maternal patients, and pediatric populations, and examines state-level and hospital-level variations in care. The majority of sepsis-related hospitalizations begin in the emergency department, where timely recognition and intervention are critical. The report underscores the importance of early recognition and the use of standardized sepsis care bundles, such as those promoted by the Surviving Sepsis Campaign, which have been shown to improve outcomes but remain underutilized.
AHRQ's findings emphasize the need for continued investments in surveillance and quality improvement programs to ensure better sepsis care and reduce the burden on hospitals. Disparities and geographic variations present opportunities for targeted interventions aimed at improving patient outcomes and addressing financial strains on the healthcare system.
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AHRQ also highlights three new health policy articles that explore critical issues surrounding hospital management of sepsis and associated costs. These studies delve into hospital coding intensity, the impact of Medicare's sepsis reporting policy, and the variation in hospital spending on sepsis care.
"Development of a Hospital Coding Intensity Measure Based on Sepsis Diagnoses" by Michael Ellenbogen et al. explores how variations in hospital coding practices affect sepsis diagnoses. The authors developed a novel measure to compare hospital coding intensity using sepsis-related diagnoses among patients hospitalized for common infections. This measure aims to correct reimbursement inequities and improve the accuracy of risk adjustment for quality metrics, offering a more targeted approach to coding intensity evaluation across hospitals.
"Association Between Medicare's Sepsis Reporting Policy (SEP-1) and the Documentation of a Sepsis Diagnosis in the Clinical Record" by Ian Barbash et al. evaluates the effect of Medicare’s SEP-1 reporting policy on sepsis documentation in clinical records. The study found that implementation of SEP-1 modestly increased sepsis diagnosis rates, particularly among patients who did not require vasopressors. Despite the incremental increase, the study calls attention to the policy’s potential influence on documentation practices and raises questions about its clinical impact.
"Identifying Sources of Inter-Hospital Variation in Episode Spending for Sepsis Care" by Roshun Sankaran et al. investigates the factors contributing to significant variation in 90-day episode spending for sepsis care across hospitals. The study found that post-acute care spending was the primary driver of these variations, with the most expensive hospitals spending nearly double on post-acute care compared to the least expensive hospitals. The analysis points to the need for targeted policies to address these cost discrepancies, particularly in the realm of post-acute care.
These articles provide important insights for policymakers looking to improve hospital efficiency, coding accuracy, and spending management in sepsis care.
