Nicholas M Mohr1, Karisa K Harland2, Dan M Shane3, Azeemuddin Ahmed4, Brian M Fuller5, James C Torner6. 1. Department of Emergency Medicine, Division of Critical Care, Department of Anesthesia, University of Iowa Carver College of Medicine, 200 Hawkins Drive, 1008 RCP, Iowa City, IA 52242. Electronic address: nicholas-mohr@uiowa.edu. 2. Department of Emergency Medicine, University of Iowa Carver College of Medicine, 200 Hawkins Drive, 1008 RCP, Iowa City, IA 52242. Electronic address: kari-harland@uiowa.edu. 3. Department of Health Management and Policy, University of Iowa College of Public Health, 145 N. Riverside Drive, N244 CPHB, Iowa City, IA 52242. Electronic address: dan-shane@uiowa.edu. 4. Department of Emergency Medicine, University of Iowa Carver College of Medicine, 200 Hawkins Drive, 1008 RCP, Iowa City, IA 52242. Electronic address: azeemuddin-ahmed@uiowa.edu. 5. Division of Critical Care, Department of Anesthesia, Division of Emergency Medicine, One Brookings Drive, CB 8072, St. Louis, MO 63130. Electronic address: fullerb@wustl.edu. 6. Department of Epidemiology, University of Iowa College of Public Health, 145 N. Riverside Drive, S441A CPHB, Iowa City, IA 52242. Electronic address: james-torner@uiowa.edu.
Abstract
PURPOSE: The objective of this study was to evaluate the impact of regionalization on sepsis survival, to describe the role of inter-hospital transfer in rural sepsis care, and to measure the cost of inter-hospital transfer in a predominantly rural state. MATERIALS AND METHODS: Observational case-control study using statewide administrative claims data from 2005 to 2014 in a predominantly rural Midwestern state. Mortality and marginal costs were estimated with multivariable generalized estimating equations models and with instrumental variables models. RESULTS: A total of 18 246 patients were included, of which 59% were transferred between hospitals. Transferred patients had higher mortality and longer hospital length-of-stay than non-transferred patients. Using a multivariable generalized estimating equations (GEE) model to adjust for potentially confounding factors, inter-hospital transfer was associated with increased mortality (aOR 1.7, 95% CI 1.5-1.9). Using an instrumental variables model, transfer was associated with a 9.2% increased risk of death. Transfer was associated with additional costs of $6897 (95% CI $5769-8024). Even when limiting to only those patients who received care in the largest hospitals, transfer was still associated with $5167 (95% CI $3696-6638) in additional cost. CONCLUSIONS: The majority of rural sepsis patients are transferred, and these transferred patients have higher mortality and significantly increased cost of care.
PURPOSE: The objective of this study was to evaluate the impact of regionalization on sepsis survival, to describe the role of inter-hospital transfer in rural sepsis care, and to measure the cost of inter-hospital transfer in a predominantly rural state. MATERIALS AND METHODS: Observational case-control study using statewide administrative claims data from 2005 to 2014 in a predominantly rural Midwestern state. Mortality and marginal costs were estimated with multivariable generalized estimating equations models and with instrumental variables models. RESULTS: A total of 18 246 patients were included, of which 59% were transferred between hospitals. Transferred patients had higher mortality and longer hospital length-of-stay than non-transferred patients. Using a multivariable generalized estimating equations (GEE) model to adjust for potentially confounding factors, inter-hospital transfer was associated with increased mortality (aOR 1.7, 95% CI 1.5-1.9). Using an instrumental variables model, transfer was associated with a 9.2% increased risk of death. Transfer was associated with additional costs of $6897 (95% CI $5769-8024). Even when limiting to only those patients who received care in the largest hospitals, transfer was still associated with $5167 (95% CI $3696-6638) in additional cost. CONCLUSIONS: The majority of rural sepsispatients are transferred, and these transferred patients have higher mortality and significantly increased cost of care.
Authors: Brett A Faine; Joseph M Noack; Terrance Wong; Jeffrey T Messerly; Azeemuddin Ahmed; Brian M Fuller; Nicholas M Mohr Journal: Crit Care Med Date: 2015-12 Impact factor: 7.598
Authors: Marian P LaMonte; Mona N Bahouth; Laurence S Magder; Richard L Alcorta; Robert R Bass; Brian J Browne; Douglas J Floccare; Wade R Gaasch Journal: Ann Emerg Med Date: 2008-12-19 Impact factor: 5.721
Authors: R P Dellinger; Mitchell M Levy; Andrew Rhodes; Djillali Annane; Herwig Gerlach; Steven M Opal; Jonathan E Sevransky; Charles L Sprung; Ivor S Douglas; Roman Jaeschke; Tiffany M Osborn; Mark E Nunnally; Sean R Townsend; Konrad Reinhart; Ruth M Kleinpell; Derek C Angus; Clifford S Deutschman; Flavia R Machado; Gordon D Rubenfeld; Steven Webb; Richard J Beale; Jean-Louis Vincent; Rui Moreno Journal: Intensive Care Med Date: 2013-01-30 Impact factor: 17.440
Authors: Steven A Ilko; J Priyanka Vakkalanka; Azeemuddin Ahmed; Karisa K Harland; Nicholas M Mohr Journal: Crit Care Med Date: 2019-05 Impact factor: 7.598
Authors: Adam Froehlich; Ryan J Tegtmeier; Brett A Faine; Jennifer Reece; Azeemuddin Ahmed; Nicholas M Mohr Journal: J Crit Care Date: 2019-04-19 Impact factor: 3.425
Authors: J Priyanka Vakkalanka; Karisa K Harland; Morgan B Swanson; Nicholas M Mohr Journal: J Epidemiol Community Health Date: 2018-04-10 Impact factor: 3.710
Authors: Tyler J Loftus; Quran Wu; Zhongkai Wang; Nicholas Lysak; Frederick A Moore; Azra Bihorac; Philip A Efron; Alicia M Mohr; Scott C Brakenridge Journal: J Trauma Acute Care Surg Date: 2020-01 Impact factor: 3.697
Authors: Nicholas M Mohr; Karisa K Harland; Uche E Okoro; Brian M Fuller; Kalyn Campbell; Morgan B Swanson; Stephen Q Simpson; Edith A Parker; Luke J Mack; Amanda Bell; Katie DeJong; Brett Faine; Anne Zepeski; Keith Mueller; Elizabeth Chrischilles; Christopher R Carpenter; Michael P Jones; Marcia M Ward Journal: J Comp Eff Res Date: 2021-01-20 Impact factor: 1.744
Authors: Nicholas M Mohr; Kalyn D Campbell; Morgan B Swanson; Fred Ullrich; Kimberly A Merchant; Marcia M Ward Journal: J Telemed Telecare Date: 2020-01-05 Impact factor: 6.344