• Ian J Barbash and Jeremy M Kahn.
• Division of Pulmonary, Allergy, and Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States of America; CRISMA Center, Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States of America; UPMC Health System, Pittsburgh, PA, United States of America. Electronic address: barbashij@upmc.edu.
• J Crit Care. 2019 Dec 1; 54: 88-93.

PurposeNewly enacted policies at the state and federal level in the United States require acute care hospitals to engage in sepsis quality improvement. However, responding to these policies requires considerable resources and may disproportionately burden safety-net hospitals. To better understand this issue, we analyzed the relationship between hospital safety-net status and performance on Medicare's SEP-1 quality measure.Materials And MethodsWe linked multiple publicly-available datasets with information on SEP-1 performance, structural hospital characteristics, hospital financial case mix, and health system affiliation. We analyzed the relationship between hospital safety-net status and SEP-1 performance, as well as whether hospital characteristics moderated that relationship.ResultsWe analyzed data from 2827 hospitals, defining safety-net hospitals using financial case mix data. The 703 safety-net hospitals performed worse on Medicare's SEP-1 quality measure (adjusted difference 2.3% compliance, 95% CI -4.0%--0.6%). This association was most evident in hospitals not affiliated with health systems, in which the difference between safety-net and non-safety-net hospitals was 6.8% compliance (95% CI -10.4%--3.3%).ConclusionsExisting sepsis policies may harm safety-net hospitals and widen health disparities. Our findings suggest that strategies to promote collaboration among hospitals may be an avenue for sepsis performance improvement in safety-net hospitals.Copyright © 2019 Elsevier Inc. All rights reserved.

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