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The 130th Annual Meeting of APHA |
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The 130th Annual Meeting of APHA |
William Buczko, PhD, Office of Research, Development and Information, DHHS/Centers for Medicare & Medicaid Services, 7500 Security Blvd. C3-19-07, Baltimore, MD 21244-1850, 410-786-6593, WBuczko@cms.hhs.gov
This study examines the incidence of hospitalizations for septicemia among Medicare beneficiaries. Septicemia is due to invasion of the circulatory system by bacteria. The incidence of septicemia increases with age. Hospitalization is necessary when septicemia is diagnosed. Although the majority of these hospitalizations are associated with community-acquired infections, a high percentage of cases involve nosocomial infections implying excess days of care and mortality. The primary infection occurs usually in the genitourinary or gastrointestinal tract, lungs or at the site of a decubitus ulcer or other skin penetration. Metastatic infections can develop which greatly complicate treatment. Mortality rates for patients hospitalized for septicemia are high (25-40%), especially in patients with nosocomial infections, septic shock or other comorbidities. Previous studies related increasing age to greater case severity and risk of mortality. The data analysis examines MEDPAR inpatient hospital discharge data for Medicare fee-for-service beneficiaries during fiscal year 1999 for DRGs 416 and 417 (N=196,607). Incidence patterns and length of stay are examined by Medicare beneficiary group, age, race, sex, and beneficiary location (urban/rural). Source of admission and discharge destination are also examined. Approximately 89% of Medicare beneficiaries hospitalized for septicemia were age 65 or over. The average patient was 77 years old. Nearly 59% of these patients were female and only 5.4% of these patients were ESRD beneficiaries. Approximately 80% of the patients were white and 14.7% were black. For all patients, 69.7% of admissions came from the emergency room. Only 7.1 percent of hospitalizations were elective admissions. The average length of stay for these hospitalizations was 7.4 days. The average inpatient charge was $15,917, which is slightly more than the average charge for all Medicare inpatient discharges ($15,373). Black patients had significantly longer and costlier stays than white patients. Often Medicare beneficiaries required formal care after their hospital stay. While only 34.2% of patients were discharged to home, 43.7% were discharged to some form of postacute care. Beneficiaries in older age groups had a higher frequency of discharge to postacute care (most often SNF care). Mortality in hospital is significant among these patients; 19.0% of them died during their hospitalization. Also, 50.5% of all patients were dead within a year after discharge. In-hospital and post-discharge mortality increased among older age groups and patients discharged to institutional postacute care.
Learning Objectives: The session participant will be able to
Keywords: Medicare, Infant Health
Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.