Original articleQuantifying the improvement in sepsis diagnosis, documentation, and coding: the marginal causal effect of year of hospitalization on sepsis diagnosis
Section snippets
Study design and population
We conducted a retrospective cohort study of patients with the SIRS at Barnes-Jewish Hospital (BJH), a 1250-bed academic tertiary care referral center in St Louis, MO. BJH is affiliated with the Washington University School of Medicine and has more than 50,000 inpatient admissions annually. Patient-level clinical and administrative data from BJH were obtained from the BJC Center for Clinical Excellence medical informatics data repository.
Eligible participants included all patients (aged
Results
The characteristics of the study population are listed in Table 1. A total of 98,267 (of 273,266 total; 36.0%) hospitalizations with oneday or multiday episodes of SIRS in 66,208 (of 150,559 total; 44.0%) patients were included in the cohort. There were 16,056 (24.3%) patients who were hospitalized more than once during the study period. In the final study population, 8115 (8.3%) hospitalizations had an International Classification of Diseases, Ninth Revision, Clinical Modification discharge
Discussion
This is the first study that quantifies the coinciding improvement in the clinical diagnosis, documentation and subsequent coding of sepsis using patient-level data from a large tertiary care center. The results of the study suggest significant increase in the discharge diagnosis of sepsis between 2008 and 2012 that was causally related to the year of hospitalization; that is, had the hospitalization occurred in 2012, patients would have had a higher probability of having a discharge diagnosis
Acknowledgments
This work was supported by the Prevention Epicenters Program from the Centers for Disease Control and Prevention (Grant U54 CK000162) and the Washington University Institute of Clinical and Translational Sciences from the National Center for Advancing Translational Sciences (Grant UL1 TR000448). The content is solely the responsibility of the authors and does not necessarily represent the official views of the Centers for Disease Control and Prevention and the National Institutes of Health.
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All authors have no reported conflicts of interest.