Table 3.
Summary description of five-class model key findings
| Low Risk, Barriers to Care (Group 1) | Previously Healthy with Severe Illness and Complex Needs after Discharge, Barriers to Care (Group 2) | Multimorbidity (Group 3) | Poor Functional Status (Group 4) | Existing Poor Health with Severe Illness and Complex Needs after Discharge (Group 5) | |
|---|---|---|---|---|---|
| Class size | 5,045 (24.3%) | 2,845 (13.7%) | 5,716 (27.6%) | 2,850 (13.7%) | 4,289 (20.7%) |
| Class-defining variables | • Financial barriers to care • Few comorbidities • Infrequent organ support |
• Financial barriers to care • Required organ support • Delirium • Long hospital stay • Frail at discharge • Acquired new device/wound • Polypharmacy at discharge |
• Immunosuppressed • High comorbidity • Frequent hospitalization • Infrequent organ support |
• Frail at discharge • High functional needs • Discharge to facility |
• High comorbidity • Frequent hospitalization • Required organ support • Delirium • Long hospital stay • Acquired new device/wound • High functional needs |
| Baseline characteristics | Younger Female GU, SSTI infections |
Younger Male Respiratory, bloodstream infections |
Older Malignancy Abdominal infections |
Older Dementia GU infections |
Older Respiratory, bloodstream infections |
| Mortality, % ± SE | 0.1 ± 0.12 | 2.1 ± 0.35 | 2.1 ± 0.25 | 6.9 ± 0.63 | 7.9 ± 0.46 |
| Readmission, % ± SE | 8.6 ± 0.48 | 20.1 ± 0.88 | 26.0 ± 0.67 | 21.6 ± 1.11 | 35.1 ± 0.82 |
| Proportion of readmissions for ACS | 29.1% | 17.4% | 27.7% | 47.2% | 26.5% |
| Potential target intervention | Readmission rate low but second highest for ACS readmission: addressing healthcare access or community support may prevent readmission or index admission | Readmissions may be appropriate/necessary; specialized care program such as post-ICU clinic or sepsis navigator may be able to address high-acuity postdischarge needs. Addressing healthcare access may result in reduced severity at presentation | Specialty care follow-up and attention to interaction between sepsis and underlying comorbidities may reduce readmissions | Nearly half of readmissions potentially avoidable (good metric to track); geriatrics or physiatry/rehabilitation referral, infection prevention practices, ascertain goals of care | Focus on goal-concordant care; palliative care involvement, multicomponent recovery interventions likely required |
Definition of abbreviations: ACS = ambulatory care–sensitive condition; GU = genitourinary; ICU = intensive care unit; SE = standard error; SSTI = skin and soft tissue infection.