A New York program requiring acute-care hospitals to develop sepsis protocols has improved detection and treatment, but the results weren't as pronounced in hospitals that serve higher proportions of black patients, according to a new study.
Since the program started in 2014, the proportion of patients who underwent the sepsis protocol increased from 61% in 2014 to 72% in 2016, and in-hospital mortality fell from 25% to 21%, according to research published Monday in Health Affairs.
But black patients experienced the lowest increase in completion of the protocol at only 5 percentage points compared to 6.7 percentage points among Hispanics, 8.4 points among Asians, and 14 points among white patients.
"If you show up at the same hospital and if you're white or black of Hispanic, we found that you get treated the same with regard to the completion of the sepsis protocol," said study first author Dr. Keith Corl, assistant professor in the division of pulmonary critical care at Brown University's Warren Alpert Medical School. "But the hospitals that care for predominantly minority populations were the hospitals that did not make improvements."
Experts say federal policymakers should examine whether hospital quality care initiatives may inadvertently exacerbate racial health disparities among minority patient populations.
The study looked at the percentage of patients that received a measurement of lactic acid levels, had blood cultures drawn and received broad-spectrum antibiotics within three hours of presenting at the hospital from April 2014 through June 2016. The three-hour protocol is based on best practice guidelines for managing sepsis first developed in 2004 by the global Surviving Sepsis Campaign and updated every four years.
Researchers did not find a significant change in hospital mortality rates between racial and ethnic groups, despite the disparities in care delivery. During the first three months of the initiative, 25.8% of white sepsis patients and 25.4% of black sepsis patients died while in the hospital. Two years into the initiative, 21.3% of white sepsis patients and 23.1% of black sepsis patients died while in the hospital.
But Corl said the findings could have broader implications if the CMS moves forward with plans to tie hospital's compliance with sepsis protocols to their reimbursement as part of its inpatient quality measures.
"If they tie financial incentives to it, that could further exacerbate the disparity," Corl said.
Corl cited previous research that has found hospitals that serve a higher proportion of minorities tended to have fewer resources to commit toward investing in quality improvements, contributing to the disparity in outcomes.
Rather than requiring hospitals to meet a single standard, the CMS should look at each facility's improvement on sepsis metrics and base reimbursement off that work, Corl suggested.
Sepsis remains one of the hardest and most costly conditions for hospitals despite years of efforts toward reducing its effects. More than 1.7 million adults are diagnosed with sepsis in the U.S. each year, resulting in 270,000 deaths, according to the Centers for Disease Control and Prevention. In 2013, sepsis was named the most expensive health condition treated in U.S. hospitals, costing more than $23 billion a year, according to a 2016 Agency for Healthcare Research and Quality report.
Its burden has only grown in recent years. A report published in March by Premier found that the expense of treating sepsis patients rose by 20% over three years, costing hospitals $1.5 billion more in 2018 than in 2015.
