Implementation of the Affordable Care Act: A Comparison of Outcomes in Patients With Severe Sepsis and Septic Shock Using the National Inpatient Sample*

Objectives: Sepsis is the most common and costly diagnosis in U.S.’ hospitals. Despite quality improvement programs and heightened awareness, sepsis accounts for greater than 50% of all hospital deaths. A key modifier of outcomes is access to healthcare. The Affordable Care Act, passed in 2010, expanded access to health insurance coverage. The purpose of this study was to evaluate changes in insurance coverage and outcomes in patients with severe sepsis and septic shock as a result of the full implementation of the Affordable Care Act. Design: This retrospective study uses data from the Healthcare Cost and Utilization Project National Inpatient Sample during 2011–2016. Data were divided into two groups: 2011–2013 (pre Affordable Care Act) and 2014–2016 (post Affordable Care Act). Outcomes were in-hospital mortality, mortality rates based on insurance type, and hospital length of stay. Patients: Hospitalized adults between the ages 18 and 64. Interventions: None. Measurements and Main Results: A total of 361,323 severe sepsis or septic shock hospital discharges were included. Comparing pre-Affordable Care Act with post-Affordable Care Act, there was a 4.75% increase in medicaid coverage and a 1.91% decrease in the uninsured. Overall in-hospital mortality decreased from 22.90% pre-Affordable Care Act to 18.59% post-Affordable Care Act. Pre-Affordable Care Act uninsured patients had the highest mortality (25.68%). Patients with medicaid had the greatest red...
Source: Critical Care Medicine - Category: Emergency Medicine Tags: Feature Articles Source Type: research