This cohort study examines the risk factors for long-term mortality and the patterns of end-of-life care among a national population of adult sepsis survivors who are Medicare fee-for-service beneficiaries and have been discharged to home health care.
Key Points Question What are the risk factors for long-term mortality and patterns of end-of-life care among sepsis survivors who are Medicare beneficiaries and have been discharged to home health care? Findings In this cohort study of 87 581 adult sepsis survivors who are Medicare fee-for-service beneficiaries and have been discharged to home health care, 1 in 4 survivors died within 1 year, and among the decedents, hospitalization and intensive care unit use in the last 30 days of life and in-hospital death were common. Several factors were found to be associated with an increased risk of mortality. Meaning The findings of this study suggest that home health assessments may provide an opportunity to identify high-risk sepsis survivors and target efforts to improve their end-of-life care.
Importance Despite a growing recognition of the increased mortality risk among sepsis survivors, little is known about the patterns of end-of-life care among this population. Objective To describe patterns of end-of-life care among a national sample of sepsis survivors and identify factors associated with long-term mortality risk and hospice use. Design, Setting, and Participants This cohort study assessed sepsis survivors who were Medicare fee-for-service beneficiaries discharged to home health care using national Medicare administrative, claims, and home health assessment data from 2013 to 2014. The initial and final primary analyses were conducted in July 2017 and from July to August 2019, respectively. Exposures Sepsis hospital discharge and 1 or more home health assessments within 1 week. Main Outcomes and Measures Outcomes were 1-year mortality among all sepsis survivors and hospitalization in the last 30 days of life, death in an acute care hospital, and hospice use among decedents. Multivariate logistic regression was used to identify factors associated with 1-year mortality and hospice use. Results Among 87 581 sepsis survivors who were Medicare fee-for-service beneficiaries discharged to home health care, 49 323 (56.3%) were aged 75 years or older, 69 499 (79.4%) were non-Hispanic white, and 48 472 (55.3%) were female. Among the total survivors, 24 423 (27.9%) people died within 1 year of discharge, with a median (interquartile range) survival time of 119 (51-220) days. Among these decedents, 16 684 (68.2%) were hospitalized in the last 30 days of life, 6560 (26.8%) died in an acute care hospital, and 12 573 (51.4%) were enrolled in hospice, with 5729 (45.6%) using hospice for 7 or fewer days. Several factors were associated with 1-year mortality, including a cancer diagnosis (odds ratio [OR], 3.66; 95% CI, 3.50-3.83; P