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Sepsis mortality linked to concentration of critical care fellowships



– Compared with other parts of the United States, survival rates for sepsis were highest in the Northeast and in metropolitan areas in the Western regions of the United States, which mirrors the concentration of critical care fellowship programs, results from a descriptive analysis found.

“There must be consideration to redistribute the critical care work force based on the spread of the malady that they are trained to deal with,” lead study author Aditya Shah, MD, said in an interview in advance of the annual meeting of the American College of Chest Physicians. “This could be linked to better reimbursements in the underserved areas.”

Dr. Aditya Shah

Dr. Shah, an internal medicine resident at Advocate Christ Medical Center in Oak Lawn, Ill., and his associates, extracted sepsis mortality data from the National Center for Health Statistics (NCHS)’ Compressed Mortality File, which aggregates US death incidence with regards to geographical distribution. They defined sepsis death as death attributed to an infection. The researchers used National Residency Matching Program data to determine the located of current critical care fellowships. Next, they used using Google fusion tables to map the data and studied them in relation to deaths attributed to infection in the continental United States, after running algorithms through the NCHS software, selecting deaths from infections, in age groups 20 years and older, in all races, and both sexes, with state-wise charting of the data.

Dr. Shah has conducted similar projects in patient populations with HIV and hepatitis, but to his knowledge, this is the first such analysis using NCHS data. “What is unique about this is that we can make real time presentations to see how the work force and the pathology is evolving with regards to an epidemiological stand point with real time data, which can be easily accessed,” he explained. “Depending on what we see, interventions and redistributions could be made with regards to better distributing providers based on where they are needed the most.”

Of 150 critical care fellowship programs identified in the analysis, the majority were concentrated in the Northeast and metropolitan areas in the Western regions of the United States, which parallel similar patterns noted in other specialties. Survival rates for sepsis were also higher in these locations. Dr. Shah said that the findings support previous studies, which indicated that physicians often tend to practice in geographic areas close to their training sites. However, the fact that such variation existed in mortality from sepsis – one of the most common diagnoses in the medical and surgical intensive care units – surprised him. “You would have thought that there would be a work force to deal with this malady,” he said.

He acknowledged certain limitations of the study, including the fact that the NCHS data do not enable researchers to break down mortality from particular causes of sepsis. “Also, the most current data will always lag behind as it is entered retrospectively and needs time to be uploaded online,” he said. “I am still in search of a more real-time database. However, that would require much more intensive time, money, and resources.”

Dr. Shah reported having no financial disclosures.

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