Geographic Clusters in Sepsis Hospital Mortality and the… : Critical Care Medicine
low-performing hospitals to higher-performing hospitals within a cluster will improve sepsis outcomes. Design, Setting, and Patients: We conducted a cohort study of age-qualifying Medicare beneficiaries using administrative claims data from 2013 to 2015. We calculated risk-standardized mortality for hospitals then used a clustering algorithm to define geospatial cluster boundaries based on care-seeking and interhospital transfer patterns. Finally, we used simulation to model the effect of reallocating sepsis patients to higher-performing hospitals within the same cluster. Interventions: None. Measurements and Main Results: We included 1,125,308 patients, and they were grouped into 222 regional clusters. High-performing clusters were located largely in the Midwest, and they tended to be in less urban regions with smaller hospitals. In our simulation, the most impactful strategy was reassigning cases from the lowest-performing hospital in a cluster to the highest-performing hospital in t
