Implementation of the Affordable Care Act: A Comparison of Outcomes in Patients With Severe Sepsis and Septic Shock Using the National Inpatient Sample
| Autor: | John P. Gaughan, Christa A. Schorr, Brian Chinai |
|---|---|
| Rok vydání: | 2020 |
| Předmět: |
Adult
Male CARE Act medicine.medical_specialty Adolescent Population Critical Care and Intensive Care Medicine Health Services Accessibility Insurance Coverage 03 medical and health sciences Young Adult 0302 clinical medicine Sepsis Health care Medicine Humans Hospital Mortality Healthcare Cost and Utilization Project education Retrospective Studies education.field_of_study Insurance Health business.industry Septic shock Medicaid Mortality rate Patient Protection and Affordable Care Act 030208 emergency & critical care medicine Retrospective cohort study Length of Stay Middle Aged medicine.disease Shock Septic United States 030228 respiratory system Emergency medicine Female business |
| Zdroj: | Critical care medicine. 48(6) |
| ISSN: | 1530-0293 |
| Popis: | Objectives Sepsis is the most common and costly diagnosis in U.S.' hospitals. Despite quality improvement programs and heightened awareness, sepsis accounts for greater than 50% of all hospital deaths. A key modifier of outcomes is access to healthcare. The Affordable Care Act, passed in 2010, expanded access to health insurance coverage. The purpose of this study was to evaluate changes in insurance coverage and outcomes in patients with severe sepsis and septic shock as a result of the full implementation of the Affordable Care Act. Design This retrospective study uses data from the Healthcare Cost and Utilization Project National Inpatient Sample during 2011-2016. Data were divided into two groups: 2011-2013 (pre Affordable Care Act) and 2014-2016 (post Affordable Care Act). Outcomes were in-hospital mortality, mortality rates based on insurance type, and hospital length of stay. Patients Hospitalized adults between the ages 18 and 64. Interventions None. Measurements and main results A total of 361,323 severe sepsis or septic shock hospital discharges were included. Comparing pre-Affordable Care Act with post-Affordable Care Act, there was a 4.75% increase in medicaid coverage and a 1.91% decrease in the uninsured. Overall in-hospital mortality decreased from 22.90% pre-Affordable Care Act to 18.59% post-Affordable Care Act. Pre-Affordable Care Act uninsured patients had the highest mortality (25.68%). Patients with medicaid had the greatest reduction in mortality (5.71%) and length of stay (2.45 d). The mean (SD) length of stay pre Affordable Care Act was 13.92 (17.42) days, compared with 12.35 (15.76) days post Affordable Care Act. All results were statistically significant (p Conclusions In this cohort, there was an increase in insured patients with severe sepsis and septic shock post Affordable Care Act. Mortality and length of stay decreased in the post-Affordable Care Act period with the greatest reduction identified in the medicaid population. The improvement in outcomes could be attributed to advances in management, earlier presentation, patients being less severely ill and receiving treatment sooner. |
| Databáze: | OpenAIRE |
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