Trends and Disparities in Post-acute Care Utilization After Hospitalization for Sepsis in the United States: A Systematic Review.

BACKGROUND

Post-acute care (PAC) utilization following sepsis hospitalization remains understudied, particularly concerning racial and ethnic and urban-rural disparities.

OBJECTIVES

To examine trends and disparities in PAC utilization after sepsis hospitalization, focusing on race, ethnicity, and rurality.

METHODS

A comprehensive search of databases (PubMed, CINAHL, Embase, Web of Science, and Scopus) was conducted for eligible studies using data through March 2020. The Social Ecological Model guided the review.

RESULTS

Eleven studies met inclusion criteria. Our synthesis found a discontinuous increase in PAC use, with a shift from home discharges toward greater use of nursing homes and home health care after 2006. White patients had higher PAC utilization than racial and ethnic minority individuals. Rural and urban non-teaching hospitals discharged more sepsis survivors to long-term care hospitals, while urban teaching hospitals had more discharges to HHC.

CONCLUSION

This review establishes a pre-reform, pre-pandemic baseline for PAC utilization among sepsis survivors. Despite overall gains, disparities in PAC utilization persist by race, ethnicity, and hospital type. As payment and care delivery models have evolved since 2016, future research should leverage this historical baseline to assess the impact of new policies on equitable PAC access for sepsis survivors.