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Variation in Identifying Sepsis and Organ Dysfunction Using Administrative versus Electronic Clinical Data and Impact on Hospital Outcome Comparisons
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April 2019
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Source: Crit Care Med. 47(4):493-500
[PDF-260.17 KB]
Details:
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Alternative Title:Crit Care Med
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Personal Author:
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Description:Objectives:
Administrative claims data are commonly used for sepsis surveillance, research, and quality improvement. However, variations in diagnosis, documentation, and coding practices for sepsis and organ dysfunction may confound efforts to estimate sepsis rates, compare outcomes, and perform risk-adjustment. We evaluated hospital variation in the sensitivity of claims data relative to clinical data from electronic health record (EHRs) and its impact on outcome comparisons.
Design, Setting, and Patients:
Retrospective cohort study of 4.3 million adult encounters at 193 U.S. hospitals in 2013-2014.
Interventions:
None.
Measurements and Main Results:
Sepsis was defined using EHR-derived clinical indicators of presumed infection (blood culture draws and antibiotic administrations) and concurrent organ dysfunction (vasopressors, mechanical ventilation, doubling in creatinine, doubling in bilirubin to ≥2.0 mg/dL, decrease in platelets to <100 cells/μL, or lactate ≥2.0 mmol/L). We compared claims for sepsis (severe sepsis/septic shock codes) and organ dysfunction to clinical criteria and measured correlations of hospitals’ sepsis incidence and mortality rates between both methods. All estimates were reliability-adjusted to account for random variation using hierarchical logistic regression modeling. The sensitivity of hospitals’ claims data was low and variable: median 30% (range 5-54%) for sepsis, 66% (range 26-84%) for acute kidney injury, 39% (range 16-60%) for thrombocytopenia, 36% (range 29-44%) for hepatic injury, and 66% (range 29-84%) for shock. Correlation between claims and clinical data was moderate for sepsis incidence (Pearson coefficient 0.64) and mortality (0.61). Among hospitals in the lowest sepsis mortality quartile by claims, 46% shifted to higher mortality quartiles using clinical data. Using implicit sepsis criteria based on infection and organ dysfunction codes also yielded major differences versus clinical data.
Conclusions:
Variation in the accuracy of claims data for identifying sepsis and organ dysfunction limits their use for comparing hospitals’ sepsis rates and outcomes. Using objective clinical data may facilitate more meaningful hospital comparisons.
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Source:
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Pubmed ID:30431493
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Pubmed Central ID:PMC7970408
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Funding:
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Volume:47
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Issue:4
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