Sepsis quality in safety-net hospitals: An analysis of Medicare's SEP-1 performance measure

Abstract

Purpose: Newly enacted policies at the state and federal level in the United States require acute care hospitals to engage in sepsis quality improvement. However, responding to these policies requires considerable resources and may disproportionately burden safety-net hospitals. To better understand this issue, we analyzed the relationship between hospital safety-net status and performance on Medicare's SEP-1 quality measure.

Materials and methods: We linked multiple publicly-available datasets with information on SEP-1 performance, structural hospital characteristics, hospital financial case mix, and health system affiliation. We analyzed the relationship between hospital safety-net status and SEP-1 performance, as well as whether hospital characteristics moderated that relationship.

Results: We analyzed data from 2827 hospitals, defining safety-net hospitals using financial case mix data. The 703 safety-net hospitals performed worse on Medicare's SEP-1 quality measure (adjusted difference 2.3% compliance, 95% CI -4.0%--0.6%). This association was most evident in hospitals not affiliated with health systems, in which the difference between safety-net and non-safety-net hospitals was 6.8% compliance (95% CI -10.4%--3.3%).

Conclusions: Existing sepsis policies may harm safety-net hospitals and widen health disparities. Our findings suggest that strategies to promote collaboration among hospitals may be an avenue for sepsis performance improvement in safety-net hospitals.

Keywords: Disparities; Health policy; Sepsis.

Figure 1.

SEP-1 compliance is lower in hospitals caring for greater numbers of socioeconomically disadvantaged patients. SSI Percent is the proportion of a hospital’s Medicare patients who also receive social security income payments. The relationship between socioeconomic factors and SEP-1 compliance is particularly evident in hospitals not affiliated with health systems and in smaller hospitals. Vertical line represents cutoff between 3^rd and 4^th quartiles of SSI indicator. Hospitals to the right of the vertical line are designated as safety-net hospitals in the categorical analysis. Results adjusted for hospital SEP-1 case volume, bed size, ownership, teaching status, and rurality.