Modeling hospital discharge policies for patients with pneumonia-related sepsis

Abstract

Sepsis, the tenth-leading cause of death in the United States, accounts for more than $16.7 billion in annual health care costs. A significant factor in these costs is hospital length of stay. The lack of standardized hospital discharge policies and an inadequate understanding of sepsis progression have resulted in unnecessarily long hospital lengths of stay. In this paper, a general model of when to discharge a patient with pneumonia-related sepsis from the hospital is presented. The model is parameterized using patient-based disease progression data from a large clinical study in order to characterize optimal discharge policies for various problem instances. In the presented experiments, patient health is represented by SOFA scores, which are commonly used to assess sepsis severity. Control-limit policies for specific patient cohorts defined by age and race are demonstrated.

Keywords:

• Medical decision making
• patient management
• Markov decision processes
• sepsis
• pneumonia

Acknowledgements

J. Kreke was supported by a Graduate Fellowship through the AT&T Labs Fellowship Program. A. Schaefer was supported by grant CMMI-0546960 from the National Science Foundation. M. Roberts and D. Angus were supported by National Institute of General Medical Services grant R01 GM61992. The authors would like to thank the GenIMS investigator team for their cooperation and assistance and for providing the data for this research effort. The authors gratefully acknowledge the helpful comments of two anonymous referees and one of the guest editors, whose comments have improved the content and clarity of the paper.