Social Emergency Medicine
Background: Studies investigating the association between race or insurance status on sepsis-related mortality have shown differing results. To our knowledge, there are no previous studies examining whether these differences in mortality are associated with emergency physician compliance with the Centers for Medicare & Medicaid Services National SEP-1 Quality Measures (CMS SEP-1). This study, based in an urban, academic center that serves a predominantly black patient population, investigates whether race or insurance coverage predicts compliance with CMS SEP-1, or in-hospital mortality.
Methods: We performed a retrospective review of all adult emergency department patients with a qualifying ICD-10 sepsis code on admission from a tertiary, academic center from 10/1/17 through 8/31/18. CMS SEP-1 definitions for severe sepsis and septic shock were utilized for inclusion. Patients excluded were those who did not meet CMS SEP-1 for severe sepsis or septic shock, or lacking an affiliated ICD-10 code. Study personnel reviewed each case for CMS SEP-1 adherence and patient mortality. Chi-squared and t-tests were used for two bivariate analyses. Univariate and multivariable logistic regression were performed as indicated.
Results: 524 patients met inclusion criteria. The cohort (50% male) was predominantly black (72% vs 25% white) with a mean age of 63 (SD = 17). Insurance coverage was predominantly Medicare (58% vs. 24% Medicaid vs. 18% private insurance). Compliance rate with national SEP-1 quality measures was 46% (95% CI: 42%-50%). Mortality rate was 11% (95% CI: 9%-14%). There was no difference in compliance to national SEP-1 quality measures when analyzed by race ( p=0.908) or insurance status (p =0.219). There was no difference in sepsis-related mortality in white vs black patients (p=0.069). Medicaid (OR= 0.08; 95% CI 0.02-0.30 p<0.0001) and Medicare (OR=0.29; 95% CI 0.14- 0.63, p=0.002) were predictors of decreased mortality in comparison to patients with private insurance.
Conclusion: Few studies have investigated whether race or insurance status impact EP compliance with CMS SEP-1. Our findings suggest that adherence to CMS SEP-1 does not differ by race or insurance status. Mortality rates were found to be lower in patients with Medicare or Medicaid relative to private insurance but did not differ by race.