Coding vs. Clinical Data: Is Sepsis Incidence Actually Increasing?

9/1/18 8:00 AM

In a 2017 study by Rhee et al., published in the Journal of the American Medicine Association (JAMA), researchers sought to establish the impact of surveillance methodology on reported incidence of sepsis. In this retrospective study, researchers compared clinical and claims data in order to understand if incidence of sepsis was increasing and if sepsis-related mortality was decreasing, as suggested by claims data. To do this, the researchers compiled data from electronic health record and administrative records from 409 diverse hospitals. The researchers included data from 2009-2014 and analyzed patients 20 years and older who presented sepsis according to the Sepsis-3 definition. Sepsis incidence and trends were found using various regression models and compared with their respective claims estimates.

The authors found that by using clinical data from hospital EHRs, sepsis incidence was stable during the study period (+0.6% relative change/y) while claims data suggested that sepsis incidence was increasing rapidly (+10.3%/y). When examining the effect of surveillance methodology on sepsis-related mortality, the researchers found a slight, but insignificant decrease (−1.3%/y) using clinical data, whereas claims data suggested a significant decrease in mortality (−4.5%/y). In judging the accuracy of EHR or claims based surveillance compared to the gold-standard Sepsis-3 definition, EHR based methods demonstrated higher sensitivity but a relatively similar positive predictive value. These results led researchers to suggest that claims based methods of surveillance may be less accurate than EHR methods to determine if patients are septic.

The authors explain that claims based methods are biased due to the fact that diagnosis and coding practices tend to change over time. However, the authors note that even clinical methods based on EHR surveillance have limitations, such as only including adult patients and using data that doesn’t reflect standardized care.

Nevertheless, this study is important as it sheds light on the need to use more accurate methods to survey sepsis. It is only with accurate data that we can understand the efficacy of current sepsis management and identify potential areas of improvement.

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