Ciprofloxacin HCL is associated with Lower Hospital Readmission Rates for Sepsis Patients at AdventHealth Orlando based on Real World Evidence Study of Medicare Claims Data

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In Ciprofloxacin, Sepsis

By: Sara Riascos  May. 12, 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. Ciprofloxacin HCLis an antibiotic used to treat different types of bacterial infections. Studies have shown that Ciprofloxacin HCL should be used for severe sepsis in critically ill adults.

Dexur’s analysis of Real World Evidence based on Medicare Claims data showed that the use of Ciprofloxacin HCL within 7 days of hospitalization was associated with lower hospital readmission rates for Sepsis Patients at AdventHealth Orlando in Orlando, Florida. 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 AdventHealth Orlando 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 Ciprofloxacin HCL within 7 Days of Hospitalization using Part D drugs claims database
   2. Sepsis patients who did not dispense Ciprofloxacin HCL within 7 Days of Hospitalization
3. 30 Day readmission rates were analyzed for both population cohorts

Results:

Overall, Ciprofloxacin HCL was associated with lower hospital readmission rates for all Primary ICD Diagnosis Codes examined at AdventHealth Orlando. For patients whose primary DRG Diagnosis was “Sepsis, unspecified organism”(A419) and when Ciprofloxacin HCL was used within 7 days of hospitalization, the readmission rate was 14.67% compared to the cohort where Ciprofloxacin HCL was not used, whose readmission rate was 25.2%. The readmission odds ratio for these cohorts was 0.51. The use of Ciprofloxacin HCL was associated with a 49% lower readmission rate when used within 7 days of hospitalization. The full list of studied ICD codes, readmission rates, odds ratios, confidence intervals, and percentage reduction in readmission with Ciprofloxacin HCL at AdventHealth Orlando is shown below.

Primary ICD Diagnosis Code	Primary ICD Diagnosis Code Description	Total Hospitalizations without Ciprofloxacin HCL	Readmission Without Ciprofloxacin HCL	Readmission Rate without Ciprofloxacin HCL	Total Hospitalizations with Ciprofloxacin HCL	Readmission with Ciprofloxacin HCL	Readmission Rate with Ciprofloxacin HCL	Readmission Odds Ratio	Reduction in Readmission with Ciprofloxacin HCL (%)	Confidence Interval (-)	Confidence Intervals (+)
A419	Sepsis, unspecified organism	7,234

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

ICD CODE	Hospital	Hospitalizations with Sepsis	% of Hospitalizations without Ciprofloxacin HCL
A419	AdventHealth Orlando	7,245	99.85%
	Oroville Hospital	5,103	At least 99.75%
	Adcare Hospital Of Worcester	4,935	At least 99.68%

​Hospitalizations with Sepsis = Above Listed 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 2017 to September 2019, the use of Ciprofloxacin HCL within 7 days of hospitalization can lead to substantial reductions in hospital readmission rates of Sepsis patients at AdventHealth Orlando. This analysis shows that a significant number of Patients are not dispensed Ciprofloxacin HCL after Sepsis hospitalizations at AdventHealth Orlando or major US Hospitals.