The following is a summary of “Healthcare Use and Expenditures in Rural Survivors of Hospitalization for Sepsis,” published in the August 2024 issue of Critical Care by Stinehart et al.
Survivors of sepsis had greater healthcare use as compared to individuals hospitalized. Older rural Americans with chronic illnesses face problems with healthcare access, which affects post-sepsis healthcare use.
Researchers conducted a retrospective study to compare healthcare use and expenditures among rural and urban survivors of sepsis. The hypothesis was that rural survivors would exhibit greater healthcare use and higher costs.
They analyzed data from 106,189 adult survivors of sepsis hospitalizations using IBM MarketScan Commercial Claims, Encounters, and the Medicare Supplemental database from 2013 to 2018. The severity of sepsis and septic shock were identified using ICD-9 or ICD-10 codes. Metropolitan Statistical Area classifications were used to categorize rurality. Various healthcare services such as emergency department (ED) visits, inpatient hospitalizations, skilled nursing facility admissions, primary care, physical therapy, and occupational therapy visits, home healthcare, and expenditures in the year following sepsis hospitalization were measured and compared between rural and urban patients using multivariable regression, adjusting for factors such as age, sex, comorbidities, admission type, insurance type, U.S. Census Bureau region, employment status, and sepsis severity.
The results showed after adjustment, rural survivors of sepsis had 17% greater odds of having an emergency department (ED) visit ( [OR] 1.17; 95% CI, 1.13–1.22; P < 0.001), 9% lower odds of having a primary care visit (OR 0.91; 95% CI, 0.87–0.94; P < 0.001), and 12% lower odds of receiving home healthcare (OR 0.88; 95% CI, 0.84–0.93; P < 0.001). Despite higher ED use and equivalent hospital readmissions, expenditures were 14% lower for ED visits (OR 0.86; 95% CI, 0.80–0.91; P < 0.001) and 9% lower for hospital readmissions (OR 0.91; 95% CI, 0.87–0.96; P < 0.001) among rural survivors.
They concluded that there were significant healthcare use and expenditure differences between rural and urban survivors of sepsis.
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