Chanu Rhee, M.D., M.P.H., is an infectious disease and critical care physician at Brigham and Women’s Hospital in Boston. His research focus is the epidemiology, surveillance, diagnosis, treatment and prevention of sepsis and infections in critically ill patients. He recently completed a CDC-funded, multicenter collaborative that developed an objective surveillance definition for sepsis based on clinical data and estimated the U.S. national burden of sepsis by applying this definition to electronic health record data from over 400 hospitals and 7 datasets. Dr. Rhee is a member of the Massachusetts Sepsis Consortium.
Betsy Lehman Center: How much do we understand about whether the incidence of sepsis is increasing and why?
Dr. Rhee: Most epidemiologic studies of sepsis suggest that its incidence is rising over time. That’s been attributed to factors such as an aging population, increasing use of immunosuppressive drugs and chemotherapy for patients with cancer, more surgical procedures and more drug resistant organisms. While these factors are certainly plausible, we may also simply be diagnosing sepsis more often than in the past. Indeed, this is what my colleagues and I have found in our research over the past few years.
Betsy Lehman Center: Based on that research, the CDC has issued a new toolkit that offers hospitals a more reliable way to measure and track sepsis. How is the new toolkit an improvement over what hospitals have done in the past?
Dr. Rhee: Most hospitals track their sepsis rates and outcomes using discharge diagnosis codes from administrative data because it’s readily available and easy to analyze. However, our research has shown that trends from administrative data are biased because practices for diagnosis and coding have changed over time. With all the national and global attention on sepsis, clinicians are becoming more aware, while also being encouraged to screen for sepsis more aggressively and code for it more diligently to maximize reimbursement. The net effect is that many patients who previously would not have been labeled with sepsis are now being counted, which can create misleading impressions of rising sepsis incidence and declining mortality rates.