Cefuroxime is associated with Lower Hospital Readmission Rates for Sepsis Patients at Yale New Haven Hospital based on Real World Evidence Study of Medicare Claims Data

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In Cefuroxime, Sepsis

Cefuroxime is associated with Lower Hospital Readmission Rates for Sepsis Patients at Yale New Haven Hospital based on Real World Evidence Study of Medicare Claims Data

By: Sara Riascos  Apr. 16, 2022

Background:

Sepsis is frequently associated with hospital readmission. Readmission is a hospital quality measure that reflects dimensions of quality of inpatient care and also impacts overall programs by payors such as CMS’s Star Rating Program, HRRP and Value-Based Purchasing. Cefuroxime is an antibiotic used to treat bacterial infections of the ear, nose, throat, lungs, skin, bones, joints, bladder, or kidneys. Studies have shown that Cefuroxime significantly reduced the frequency of sepsis after TRUSBP.

Dexur’s analysis of Real World Evidence based on Medicare Claims data showed that the use of Cefuroxime within 7 days of hospitalization was associated with lower hospital readmission rates for Sepsis Patients at Yale New Haven Hospital in New Haven, Connecticut. Reduction in readmission rates helps hospitals improve their outcomes for various cost and quality programs. Dexur is an approved entity to perform Medicare claims data analysis, which it uses to perform quality outcomes analysis. Dexur has published several papers with Harvard Medical School on quality outcomes related topics. Dexur’s analysis of Drugs and their impact on quality outcomes, such as readmissions and mortality, are used by Hospitals, IDNs, and ACOs to implement best practices and manage Real World Evidence based risk factors.

Methods:

We conducted a retrospective study using Dexur’s analysis of Real World Evidence from Medicare Claims data, for hospitalizations at Yale New Haven Hospital between January 2017 to September 2019. Our methodology criteria was as follows:

1. Inclusion Criteria: Selected Medical Hospitalizations with Primary Diagnosis with Sepsis related codes (Listed in table below)
2. Stratified Selected population into cohorts
   1. Sepsis patients who dispensed Cefuroxime within 7 Days of Hospitalization using Part D drugs claims database
   2. Sepsis patients who did not dispense Cefuroxime within 7 Days of Hospitalization
3. 30 Day readmission rates were analyzed for both population cohorts

Results:

Overall, Cefuroxime was associated with lower hospital readmission rates for all Primary DRG/ICD Diagnosis Codes examined at Yale New Haven Hospital. For patients whose primary DRG/ICD Diagnosis was “Septicemia Or Severe Sepsis Without Mv >96 Hours With Major Complication Or Comorbidity (MCC)”(871) and when Cefuroxime was used within 7 days of hospitalization, the readmission rate was 16.81% compared to the cohort where Cefuroxime was not used, whose readmission rate was 23.20%. The readmission odds ratio for these cohorts was 0.64. The use of Cefuroxime was associated with a 36% lower readmission rate when used within 7 days of hospitalization. The full list of studied DRG/ICD codes, readmission rates, odds ratios, confidence intervals, and percentage reduction in readmission with Cefuroxime at Yale New Haven Hospital is shown below.

Primary DRG/ICD Diagnosis Code	Primary DRG/ICD Diagnosis Code Description	Total Hospitalizations without Cefuroxime	Readmission Without Cefuroxime	Readmission Rate without Cefuroxime	Total Hospitalizations with Cefuroxime	Readmission with Cefuroxime	Readmission Rate with Cefuroxime	Readmission Odds Ratio	Reduction in Readmission with Cefuroxime (%)	Confidence Interval (-)	Confidence Intervals (+)
871	Septicemia Or Severe Sepsis Without Mv >96 Hours With Major Complication Or Comorbidity (MCC)	3,483	808	23.20%	68	11	16.18%	0.64	36%	-8%	-6%
A419	Sepsis, unspecified organism

Dexur also leveraged Medicare claims data to understand what percentage of patients hospitalized with Sepsis were not prescribed Cefuroxime within 7 days of discharge.

DRG/ICD CODE	Hospital	Hospitalizations with Sepsis	% of Hospitalizations without Cefuroxime
871	Yale New Haven Hospital	3,494	99.69%
	Baptist Memorial Hospital	1,999	99.40%
	Huntington Hospital	1,676	98.15%
A419	Yale New Haven Hospital	3,816	99.63%
	Kennedy University Hospital	3,011	99.60%
	Harrisburg Hospital	2,426	99.51%

​Hospitalizations with Sepsis = Above Listed DRG/ICD Codes

If figures are shared with “At Least” - this implies that the drug utilization within 7 days post hospitalization is less than 11

Conclusions:

According to analysis of Real World Evidence of Medicare Claims data, for hospitalizations between January January 2017 to September 2019, the use of Cefuroxime within 7 days of hospitalization can lead to substantial reductions in hospital readmission rates of Sepsis patients at Yale New Haven Hospital. This analysis shows that a significant number of Patients are not dispensed Cefuroxime after Sepsis hospitalizations at Yale New Haven Hospital or major US Hospitals.