Where You Live Matters

Goodwin, Andrew; Nadig, Nandita R.; McElligott, James T.; Simpson, Kit N.; Ford, Dee W.

doi:10.1016/j.chest.2016.07.004

Cited by 68 publications

(42 citation statements)

References 23 publications

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“…In their recent article, they found residence in an MUA to be associated with mortality in patients with severe sepsis, whereas there was no association with traditional zip code–based surrogates. 15 There are several possible reasons for the discrepancy with our findings. The composite MUA score captures additional factors that may negatively impact health care, which may have generated a significant association with mortality in a small-scale study.…”

Section: Discussioncontrasting

confidence: 91%

“…14 Most recently, Goodwin et al examined the association of residing in an MUA in South Carolina on the incidence and outcomes of sepsis. 15 They found an increased incidence of sepsis hospitalizations (8.6 vs 6.8 cases/1000 people, P < .01) as well as an increased risk of mortality after adjustment for severity of sepsis. These findings likely explain the uneven distribution of sepsis across zip code income quartiles seen in our analysis.…”

Section: Discussionmentioning

confidence: 93%

“…13,14 Recently, Goodwin et al demonstrated that living in medically underserved areas (MUAs) in South Carolina was associated with worse outcomes in patients with sepsis. 15 However, it has yet to be shown whether this relationship is more broadly generalizable to other areas.…”

Section: Introductionmentioning

confidence: 99%

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Association of Household Income Level and In-Hospital Mortality in Patients With Sepsis: A Nationwide Retrospective Cohort Analysis

Rush

Wiskar

Celi

et al. 2017

J Intensive Care Med

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Objective Associations between low socioeconomic status (SES) and poor health outcomes have been demonstrated in a variety of conditions. However, the relationship in patients with sepsis is not well described. We investigated the association of lower household income with in-hospital mortality in patients with sepsis across the United States. Methods Retrospective nationwide cohort analysis utilizing the Nationwide Inpatient Sample (NIS) from 2011. Patients aged 18 years or older with sepsis were included. Socioeconomic status was approximated by the median household income of the zip code in which the patient resided. Multivariate logistic modeling incorporating a validated illness severity score for sepsis in administrative data was performed. Results A total of 8 023 590 admissions from the 2011 NIS were examined. A total of 671 858 patients with sepsis were included in the analysis. The lowest income residents compared to the highest were younger (66.9 years, standard deviation [SD] = 16.5 vs 71.4 years, SD = 16.1, P < .01), more likely to be female (53.5% vs 51.9%, P < .01), less likely to be white (54.6% vs 76.6%, P < .01), as well as less likely to have health insurance coverage (92.8% vs 95.9%, P < .01). After controlling for severity of sepsis, residing in the lowest income quartile compared to the highest quartile was associated with a higher risk of mortality (odds ratio [OR]: 1.06, 95% confidence interval [CI]: 1.03–1.08, P < .01). There was no association seen between the second (OR: 1.02, 95% CI: 0.99–1.05, P = .14) and third (OR: 0.99, 95% CI: 0.97–1.01, P = .40) quartiles compared to the highest. Conclusion After adjustment for severity of illness, patients with sepsis who live in the lowest median income quartile had a higher risk of mortality compared to residents of the highest income quartile. The association between SES and mortality in sepsis warrants further investigation with more comprehensive measures of SES.

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Section: Discussioncontrasting

confidence: 91%

Section: Discussionmentioning

confidence: 93%

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Association of Household Income Level and In-Hospital Mortality in Patients With Sepsis: A Nationwide Retrospective Cohort Analysis

Rush

Wiskar

Celi

et al. 2017

J Intensive Care Med

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“…Demographic data were not collected, and data on the broader school nurse population in South Carolina were unavailable. However, researchers have shown that 246 of 424 zip codes and approximately 43% of the population aged 20 years or older were medically underserved in South Carolina in 2010 ( 15 ). As such, school nurses support the health of students from many medically underserved areas in South Carolina.…”

Section: Discussionmentioning

confidence: 99%

A Cross-Sectional Survey to Evaluate Potential for Partnering With School Nurses to Promote Human Papillomavirus Vaccination

et al. 2020

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What is already known on this topic? School nurses, as trusted community health professionals, are essential partners for improving adolescent human papillomavirus (HPV) vaccination coverage. Barriers to HPV vaccine promotion, school nurses' knowledge, and their perceived roles have been studied in some populations. What is added by this report? Among lead school nurses in South Carolina, a state with large medically underserved areas, the lack of confidence and time to interact with students and parents are key hindrances to HPV vaccine promotion. What are the implications for public health practice? Although school nurses have many competing work priorities, opportunities exist to engage them in supporting coordinated public health programs aimed at improving HPV vaccination rates in medically underserved areas.

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“…Sepsis incidence and mortality are already higher in medically underserved regions. 22 Given the resources required to respond to the SEP-1 program, optimal performance may be beyond the reach of smaller hospitals, or even larger hospitals, whose resources are already stretched to their limits. Public reporting and pay-for-performance can be adisadvantage to hospitals caring for underserved populations.…”

Section: Discussionmentioning

confidence: 99%

Hospital Perceptions of Medicare's Sepsis Quality Reporting Initiative

Barbash

Rak

Kuza

et al. 2017

Journal of Hospital Medicine

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BACKGROUND In October 2015, the Centers for Medicare and Medicaid Services (CMS) implemented the Sepsis CMS Core Measure (SEP-1) program, requiring hospitals to report data on the quality of care for their patients with sepsis. OBJECTIVE We sought to understand hospital perceptions of and responses to the SEP-1 program. DESIGN A thematic content analysis of semistructured interviews with hospital quality officials. SETTING A stratified random sample of short-stay, nonfederal, general acute care hospitals in the United States. SUBJECTS Hospital quality officers, including nurses and physicians. INTERVENTION None. MEASUREMENTS We completed 29 interviews before reaching content saturation. RESULTS Hospitals reported a variety of actions in response to SEP-1, including new efforts to collect data, improve sepsis diagnosis and treatment, and manage clinicians’ attitudes toward SEP-1. These efforts frequently required dedicated resources to meet the program’s requirements for treatment and documentation, which were thought to be complex and not consistently linked to patient-centered outcomes. Most respondents felt that SEP-1 was likely to improve sepsis outcomes. At the same time, they described specific changes that could improve its effectiveness, including allowing hospitals to focus on the treatment processes most directly associated with improved patient outcomes and better aligning the measure’s sepsis definitions with current clinical definitions. CONCLUSIONS Hospitals are responding to the SEP-1 program across a number of domains and in ways that consistently require dedicated resources. Hospitals are interested in further revisions to the program to alleviate the burden of the reporting requirements and help them optimize the effectiveness of their investments in quality-improvement efforts.

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Where You Live Matters

Abstract: Residence in a medically underserved area is associated with higher incidence and mortality rates of severe sepsis and represents a novel method of access-to-care adjustment. Traditional access-to-care surrogates, however, are poorly associated with sepsis mortality.

Cited by 68 publications

References 23 publications

Association of Household Income Level and In-Hospital Mortality in Patients With Sepsis: A Nationwide Retrospective Cohort Analysis

Association of Household Income Level and In-Hospital Mortality in Patients With Sepsis: A Nationwide Retrospective Cohort Analysis

A Cross-Sectional Survey to Evaluate Potential for Partnering With School Nurses to Promote Human Papillomavirus Vaccination

Hospital Perceptions of Medicare's Sepsis Quality Reporting Initiative

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