Association between hospital spending and in-hospital mortality of patients with sepsis based on a Japanese nationwide medical claims database study
Background: The effect of hospital spending on the mortality rate of patients with sepsis has not yet been fully elucidated. We hypothesized that hospitals that consume more medical resources would have lower mortality rates among patients with sepsis. Methods: This retrospective study used administ...
| Main Authors: | , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Elsevier
2024-01-01
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| Series: | Heliyon |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2405844023106888 |
| _version_ | 1797337052606365696 |
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| author | Takehiko Oami Toshikazu Abe Taka-aki Nakada Taro Imaeda Tuerxun Aizimu Nozomi Takahashi Yasuo Yamao Satoshi Nakagawa Hiroshi Ogura Nobuaki Shime Yutaka Umemura Asako Matsushima Kiyohide Fushimi |
| author_facet | Takehiko Oami Toshikazu Abe Taka-aki Nakada Taro Imaeda Tuerxun Aizimu Nozomi Takahashi Yasuo Yamao Satoshi Nakagawa Hiroshi Ogura Nobuaki Shime Yutaka Umemura Asako Matsushima Kiyohide Fushimi |
| author_sort | Takehiko Oami |
| collection | DOAJ |
| description | Background: The effect of hospital spending on the mortality rate of patients with sepsis has not yet been fully elucidated. We hypothesized that hospitals that consume more medical resources would have lower mortality rates among patients with sepsis. Methods: This retrospective study used administrative data from 2010 to 2017. The enrolled hospitals were divided into quartiles based on average daily medical cost per sepsis case. The primary and secondary outcomes were the average in-hospital mortality rate of patients with sepsis and the effective cost per survivor among the enrolled hospitals, respectively. A multiple regression model was used to determine the significance of the differences among hospital categories to adjust for baseline imbalances. Results: Among 997 hospitals enrolled in this study, the crude in-hospital mortality rates were 15.7% and 13.2% in the lowest and highest quartiles of hospital spending, respectively. After adjusting for confounding factors, the highest hospital spending group demonstrated a significantly lower in-hospital mortality rate than the lowest hospital spending group (coefficient = −0.025, 95% confidence interval [CI] −0.034 to −0.015; p < 0.0001). Similarly, the highest hospital spending group was associated with a significantly higher effective cost per survivor than the lowest hospital spending group (coefficient = 77.7, 95% CI 73.1 to 82.3; p < 0.0001). In subgroup analyses, hospitals with a small or medium number of beds demonstrated a consistent pattern with the primary test, whereas those with a large number of beds or academic affiliations displayed no association. Conclusions: Using a nationwide Japanese medical claims database, this study indicated that hospitals with greater expenditures were associated with a superior survival rate and a higher effective cost per survivor in patients with sepsis than those with lower expenditures. In contrast, no correlations between hospital spending and mortality were observed in hospitals with a large number of beds or academic affiliations. |
| first_indexed | 2024-03-08T09:03:49Z |
| format | Article |
| id | doaj.art-b856c25115b447bda2db9c42967a0249 |
| institution | Directory Open Access Journal |
| issn | 2405-8440 |
| language | English |
| last_indexed | 2024-03-08T09:03:49Z |
| publishDate | 2024-01-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Heliyon |
| spelling | doaj.art-b856c25115b447bda2db9c42967a02492024-02-01T06:32:04ZengElsevierHeliyon2405-84402024-01-01101e23480Association between hospital spending and in-hospital mortality of patients with sepsis based on a Japanese nationwide medical claims database studyTakehiko Oami0Toshikazu Abe1Taka-aki Nakada2Taro Imaeda3Tuerxun Aizimu4Nozomi Takahashi5Yasuo Yamao6Satoshi Nakagawa7Hiroshi Ogura8Nobuaki Shime9Yutaka Umemura10Asako Matsushima11Kiyohide Fushimi12Department of Emergency and Critical Care Medicine, Chiba University Graduate School of Medicine, Chiba, JapanHealth Services Research and Development Center, University of Tsukuba, Tsukuba, Japan; Department of Emergency and Critical Care Medicine, Tsukuba Memorial Hospital, Tsukuba, JapanDepartment of Emergency and Critical Care Medicine, Chiba University Graduate School of Medicine, Chiba, Japan; Corresponding author. Department of Emergency and Critical Care Medicine, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo, Chiba, 260-8677, Japan.Department of Emergency and Critical Care Medicine, Chiba University Graduate School of Medicine, Chiba, JapanDepartment of Emergency and Critical Care Medicine, Chiba University Graduate School of Medicine, Chiba, JapanDepartment of Emergency and Critical Care Medicine, Chiba University Graduate School of Medicine, Chiba, JapanDepartment of Emergency and Critical Care Medicine, Chiba University Graduate School of Medicine, Chiba, JapanDepartment of Critical Care Medicine, National Center for Child Health and Development, Tokyo, JapanDepartment of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, Osaka, JapanDepartment of Emergency and Critical Care Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, JapanDepartment of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, Osaka, JapanDepartment of Emergency and Critical Care, Nagoya City University Graduate School of Medical Sciences, Aichi, JapanDepartment of Health Policy and Informatics, Tokyo Medical and Dental University Graduate School of Medical and Dental Sciences, Tokyo, JapanBackground: The effect of hospital spending on the mortality rate of patients with sepsis has not yet been fully elucidated. We hypothesized that hospitals that consume more medical resources would have lower mortality rates among patients with sepsis. Methods: This retrospective study used administrative data from 2010 to 2017. The enrolled hospitals were divided into quartiles based on average daily medical cost per sepsis case. The primary and secondary outcomes were the average in-hospital mortality rate of patients with sepsis and the effective cost per survivor among the enrolled hospitals, respectively. A multiple regression model was used to determine the significance of the differences among hospital categories to adjust for baseline imbalances. Results: Among 997 hospitals enrolled in this study, the crude in-hospital mortality rates were 15.7% and 13.2% in the lowest and highest quartiles of hospital spending, respectively. After adjusting for confounding factors, the highest hospital spending group demonstrated a significantly lower in-hospital mortality rate than the lowest hospital spending group (coefficient = −0.025, 95% confidence interval [CI] −0.034 to −0.015; p < 0.0001). Similarly, the highest hospital spending group was associated with a significantly higher effective cost per survivor than the lowest hospital spending group (coefficient = 77.7, 95% CI 73.1 to 82.3; p < 0.0001). In subgroup analyses, hospitals with a small or medium number of beds demonstrated a consistent pattern with the primary test, whereas those with a large number of beds or academic affiliations displayed no association. Conclusions: Using a nationwide Japanese medical claims database, this study indicated that hospitals with greater expenditures were associated with a superior survival rate and a higher effective cost per survivor in patients with sepsis than those with lower expenditures. In contrast, no correlations between hospital spending and mortality were observed in hospitals with a large number of beds or academic affiliations.http://www.sciencedirect.com/science/article/pii/S2405844023106888Hospital spendingSepsisDiagnosis procedure combinationMedical costCritical care |
| spellingShingle | Takehiko Oami Toshikazu Abe Taka-aki Nakada Taro Imaeda Tuerxun Aizimu Nozomi Takahashi Yasuo Yamao Satoshi Nakagawa Hiroshi Ogura Nobuaki Shime Yutaka Umemura Asako Matsushima Kiyohide Fushimi Association between hospital spending and in-hospital mortality of patients with sepsis based on a Japanese nationwide medical claims database study Heliyon Hospital spending Sepsis Diagnosis procedure combination Medical cost Critical care |
| title | Association between hospital spending and in-hospital mortality of patients with sepsis based on a Japanese nationwide medical claims database study |
| title_full | Association between hospital spending and in-hospital mortality of patients with sepsis based on a Japanese nationwide medical claims database study |
| title_fullStr | Association between hospital spending and in-hospital mortality of patients with sepsis based on a Japanese nationwide medical claims database study |
| title_full_unstemmed | Association between hospital spending and in-hospital mortality of patients with sepsis based on a Japanese nationwide medical claims database study |
| title_short | Association between hospital spending and in-hospital mortality of patients with sepsis based on a Japanese nationwide medical claims database study |
| title_sort | association between hospital spending and in hospital mortality of patients with sepsis based on a japanese nationwide medical claims database study |
| topic | Hospital spending Sepsis Diagnosis procedure combination Medical cost Critical care |
| url | http://www.sciencedirect.com/science/article/pii/S2405844023106888 |
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