Diabetes mellitus (DM) increases the risk of developing infectious complications, including sepsis. Little is known about sepsis survivors with DM. Overall, there are limited and conflicting information regarding outcomes of patients with diabetes after a hospitalization for sepsis. The purpose of this study was to profile the characteristics and outcomes for sepsis survivors with (n = 80,312) and without DM (n = 84,916). The sample included Medicare beneficiaries discharged from the hospital to home health care (HHC) after a sepsis admission between July 1, 2013 and June 30, 2014. We utilized Medicare administrative claims and the Outcome and Assessment Information Set Version C start of care assessments. The incidence of older adults with DM and sepsis in HHC was 48.6%; a much higher rate than the 20-30% reported in the general hospitalized population. Those with DM and sepsis had a higher proportion of 30-day rehospitalization (24.3% verse 20.8%, p < .001) and were more likely to have a prior sepsis admission (9.28% verse 3.35%, p < .001) than sepsis patients without DM. They had more comorbid conditions (5.19 versus 3.8, p<.001) including higher rates of depression, vision loss, obesity, hypertension, heart failure, pulmonary disease, and renal failure than non-DM sepsis survivors. Approximately 50% were taking injectable medications and only 12.8% of them were able to do so independently. For those who required caregiver assistance over 25% of caregivers reported needing additional training. Sepsis survivors with DM experience significantly higher readmission rates than non-DM patients. HHC clinicians should flag the sepsis survivor with DM as high risk and target interventions to manage the increased comorbid conditions, medication management, and caregiver training issues that may be contributing to the higher readmission rates.
C.R. Whitehouse: None. L. Jordan: None. K. Bowles: None. C.M. Murtaugh: None.
National Institute of Nursing Research (R01NR016014); Visiting Nurse Service of New York; Ruth L. Kirschstein National Research Service Award; University of Pennsylvania School of Nursing