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Bernie Monegain

 

Authors from Brigham and Women's Hospital urge switch from using claims numbers to mining electronic health records.

Investigators at Brigham and Women's Hospital in Boston have found clinical data more reliable than claims statistics for measuring incidences of sepsis.

The findings, published Wednesday in JAMA, question the use of claims data for sepsis surveillance and conclude clinical surveillance using EHR data provides more objective estimates of sepsis incidence and outcomes.

“Sepsis, the syndrome of life-threatening organ dysfunction caused by infection, is a major cause of death, disability, and cost,” the researchers said.

The researchers found many studies suggest the incidence of sepsis is increasing over time, while mortality rates are decreasing. However, reliably measuring sepsis incidence and trends is challenging, they say because clinical diagnoses of sepsis are often subjective. Also, claims data – the traditional method of surveillance – can be affected by changing diagnosis and coding practices over time.

The Brigham and Women's Hospital research estimates the current U.S. burden of sepsis and trends using clinical data from electronic health record systems of a large number of diverse hospitals.

The findings, published in JAMA, challenge the use of claims data for sepsis surveillance and suggest that clinical surveillance using electronic health record data provides more objective estimates of sepsis incidence and outcomes.

The research team, led by Chanu Rhee, MD, a critical care and infectious disease physician at BWH, developed a new strategy to track sepsis incidence and outcomes using electronic clinical data instead of insurance claims.

After reviewing EHR data from nearly 3 million patients admitted to 409 U.S. hospitals in 2014, researchers found sepsis was present in six percent of all hospitalizations and in more than one in three hospitalizations that ended in death.

Using this data to gauge how many people were affected nationwide, they estimated there were approximately 1.7 million sepsis cases nationwide in 2014, and, of those, 270,000 died.

The researchers also assessed whether sepsis incidence and outcomes have changed over time. In contrast to prior claims-based estimates, they found no significant changes between 2009 and 2014.