A study published in JAMA Network Open on May 31 found that admission to safety-net hospitals was associated with higher in-hospital mortality among patients with sepsis.
Prior studies had reported higher in-hospital mortality at safety-net hospitals among patients with sepsis compared with non-safety-net hospitals. Plus, in-hospital mortality rates are “known to be associated with hospital discharge practices, which may differ between” safety-net and non-safety-net hospitals.
The researchers looked at Medicare free-for-service beneficiaries, aged 66 years or older, admitted with sepsis to an intensive care unit from January 2011 to December 2019, “based on information from the Medicare Provider Analysis and Review File.” The study measured, among several other secondary outcomes, in-hospital mortality and 30-day mortality among these patients.
Over the course of the years examined, 2,551,743 patients with sepsis were admitted to 666 safety-net hospitals and 1,924 non-safety-net hospitals. According to the study, “admission to safety-net hospitals was associated with higher in-hospital mortality…but not 30-day mortality.” Admission to safety-net hospitals was also associated with “lower do-not-resuscitate rates…palliative care delivery rates…and hospice discharge.”
The study authors conclude that these differences in in-hospital mortality “may partially be explained by greater use of hospice at non–safety-net hospitals, which shifts attribution of death from the index hospitalization to hospice.” They also emphasize that these findings show that “racial minorities and patients at minority-serving hospitals receive less palliative care.”
