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Quantifying the Improvement in Sepsis Diagnosis, Documentation and Coding: the Marginal Causal Effect of Year of Hospitalization on Sepsis Diagnosis
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Details:
  • Pubmed ID:
    26559330
  • Pubmed Central ID:
    PMC4688185
  • Description:
    Purpose

    To quantify the coinciding improvement in the clinical diagnosis of sepsis, its documentation in the electronic health records and subsequent medical coding of sepsis for billing purposes in recent years.

    Methods

    We examined 98,267 hospitalizations in 66,208 patients who met systemic inflammatory response syndrome (SIRS) criteria at a tertiary-care center from 2008-2012. We used g-computation to estimate the causal effect of the year of hospitalization on receiving an ICD-9-CM discharge diagnosis code for sepsis by estimating changes in the probability of getting diagnosed and coded for sepsis during the study period.

    Results

    When adjusted for demographics, Charlson-Deyo comorbidity index, blood culture frequency per hospitalization and ICU admission, the causal risk difference for receiving a discharge code for sepsis per 100 SIRS hospitalizations, had the hospitalization occurred in 2012, was estimated to be 3.9% (95% confidence interval [CI]: 3.8%, 4.0%), 3.4% (95% CI: 3.3%, 3.5%), 2.2% (95% CI: 2.1%, 2.3%) and 0.9% (95% CI: 0.8%, 1.1%) from 2008-2011, respectively.

    Conclusions

    Patients with similar characteristics and risk factors had a higher of probability of getting diagnosed, documented and coded for sepsis in 2012 than in previous years, which contributed to an apparent increase in sepsis incidence.

  • Document Type:
  • Collection(s):
  • Funding:
    U54 CK000162/CK/NCEZID CDC HHS/United States
    U54 CK000162/CK/NCEZID CDC HHS/United States
    UL1 TR000448/TR/NCATS NIH HHS/United States
    UL1 TR000448/TR/NCATS NIH HHS/United States
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