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Simulation findings suggest sepsis mortality may drop with patient redistribution, but improving care at underperforming hospitals may offer greater benefit.

Redistributing patients with sepsis to high-performing hospitals within defined geospatial clusters may reduce mortality, however, the benefit may be surpassed by improving care at underperforming local hospitals, according to simulation analysis findings published in Critical Care Medicine.

“Sepsis is a severe condition associated with high mortality, and hospital performance is variable,” wrote study author Alexis Zebrowski, PhD, MPH, of Mount Sinai Health System, and co-authors. “The objective of this study was to develop geospatial sepsis clusters, identify sources of variation between clusters, and test the hypothesis that redistributing sepsis patients from low-performing hospitals to higher-performing hospitals within a cluster (would) improve sepsis outcomes.”

Geospatial Clusters & Hospital Performance Variability

Using administrative claims data from 2013 to 2015, the study evaluated over 1.1 million sepsis hospitalizations among age-qualifying Medicare beneficiaries. The researchers calculated risk-standardized mortality rates for individual hospitals and then applied a clustering algorithm to define 222 geospatial clusters based on actual care-seeking and interhospital transfer patterns.

“High-performing clusters were located largely in the Midwest, and they tended to be in less urban regions with smaller hospitals,” the authors noted.

Regional Redistribution Versus Local Improvement

To test the hypothesis that strategic patient redistribution could reduce mortality, the researchers conducted a simulation in which patients with sepsis were reassigned from lower-performing hospitals in each cluster to higher-performing hospitals within the same cluster. This scenario was projected to prevent approximately 1,705 deaths annually nationwide.

However, the study found that a more modest intervention—achieving just a 1% absolute reduction in mortality across hospitals in the lower 50% of the performance spectrum—was predicted to prevent more than three times as many deaths (5,702 annually). This finding suggests that while regionalization has potential, a broader and more scalable impact may lie in systemic quality improvement initiatives focused on underperforming hospitals.

“Geospatial clusters provide insight into regional approaches to system-based acute care,” the authors concluded. “…targeted sepsis regionalization appears less effective than local performance improvement in reducing preventable sepsis deaths.”