Pamela Crabtree, CPHQ
PI Outcomes Manager II
Cooper University Health Care
Camden, NJ
Disclosure information not submitted.
Harry Bach, BS
Medical Student
Cooper Medical School at Rowan University
Camden, New Jersey, United States
Disclosure information not submitted.
Eivind Delfierro, RN
RN
Cooper University Hospital
Camden, New Jersey, United States
Disclosure information not submitted.
Krystal Hunter, MBA
Statistician
Cooper University Health Care
Camden, New Jersey, United States
Disclosure information not submitted.
Kristian Quevada, BS
Medical Student
Cooper Medical School at Rowan University
Camden, New Jersey, United States
Disclosure information not submitted.
Christa Schorr, DNP, MSN, RN, FCCM
Clinical Nurse Scientist
Cooper Hospital University Medical Center
Camden, NJ
Disclosure information not submitted.
Title: Evaluation of Adult patients readmitted for Severe Sepsis/Septic Shock in the BPCI Advanced Program
Introduction: Bundled Payments for Care Improvement-Advanced Program (BPCI-A) is designed to pay for a single payment covering all services provided during a patients episode of care across the continuum of care. Sepsis continues to be a serious health issue associated with increased mortality and healthcare costs. As many as one in three Medicare beneficiaries require readmission within the first 90 days of discharge. Developing an understanding of readmission risk factors may lead to early assessment and interventions that prevent readmission within 90 days. The purpose of the study was to evaluate Medicare BPCI program patients with severe sepsis or septic shock on index admission who were readmitted vs. not readmitted.
Methods: A retrospective cohort study of patients with severe sepsis or septic shock enrolled in the BPCI Medicare program between January 1, 2019, to December 31, 2019. Patients included with a Diagnostic Related Grouping code 870- septicemia or severe sepsis with MV >96 hours with MCC, or 871- septicemia or severe sepsis w/o mechanical ventilation >96 hours or 872- Septicemia or severe sepsis without MV >96 hours without MCC. Data was provided by Milliman reports and EPIC.
Results: We analyzed 271 patients 110 readmitted vs 161 not readmitted. Skin/soft tissue was the most common infection. A diagnosis of severe sepsis or septic shock within the first 24 hours, was noted less frequently among readmitted pts compared to no readmission pts (25.69% vs 58.39%) p=0.007. There was a significant difference between the groups for resource needs including wound care, (25.45% vs 11.18%), p=0.002 and physical therapy (74.55% vs 57.14%), p=0.004. Mortality was higher among readmissions 43.64% vs. 26.71% no readmission, p=0.004
Conclusions: Medicare BPCI program patients with severe sepsis or septic shock that are re-hospitalized within 90 days experience a higher mortality rate compared to those that are not readmitted. Although most patients originated from home, a majority of patients in both groups had a decline in functional status at hospital discharge, with many requiring physical therapy and wound care resources. Identifying risk factors for readmission, providing appropriate resources and follow-up may contribute to improved patient outcomes for sepsis patients enrolled in the BPCI program.