Elsevier

Annals of Epidemiology

Volume 26, Issue 1, January 2016, Pages 66-70
Annals of Epidemiology

Original article
Quantifying the improvement in sepsis diagnosis, documentation, and coding: the marginal causal effect of year of hospitalization on sepsis diagnosis

https://doi.org/10.1016/j.annepidem.2015.10.008Get rights and content

Abstract

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 criteria at a tertiary care center from 2008 to 2012. We used g-computation to estimate the causal effect of the year of hospitalization on receiving an International Classification of Diseases, Ninth Revision, Clinical Modification 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 intensive care unit admission, the causal risk difference for receiving a discharge code for sepsis per 100 hospitalizations with systemic inflammatory response syndrome, 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 to 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.

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.

References (39)

  • B.T. Bateman et al.

    Temporal trends in the epidemiology of severe postoperative sepsis after elective surgery: a large, nationwide sample

    Anesthesiology

    (2010)
  • M.J. Hall et al.

    Inpatient care for septicemia or sepsis: a challenge for patients and hospitals

    NCHS Data Brief

    (2011)
  • T. Lagu et al.

    Hospitalizations, costs, and outcomes of severe sepsis in the United States 2003 to 2007

    Crit Care Med

    (2012)
  • T.J. Iwashyna et al.

    Population burden of long-term survivorship after severe sepsis in older Americans

    J Am Geriatr Soc

    (2012)
  • D.F. Gaieski et al.

    Benchmarking the incidence and mortality of severe sepsis in the United States

    Crit Care Med

    (2013)
  • J.P. Sutton et al.

    Trends in septicemia hospitalizations and readmissions in selected HCUP states, 2005 and 2010: statistical brief #161. Healthc. Cost Util. Proj. HCUP Stat. Briefs

    (2013)
  • R.P. Dellinger et al.

    Surviving sepsis campaign: international guidelines for management of severe sepsis and septic shock: 2012

    Crit Care Med

    (2013)
  • J.C. Marshall et al.

    The Surviving Sepsis Campaign: a history and a perspective

    Surg Infect

    (2010)
  • M.A. Hernán

    A definition of causal effect for epidemiological research

    J Epidemiol Community Health

    (2004)
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    All authors have no reported conflicts of interest.

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