College of Graduate Studies: Theses & Dissertations

Term of Award

Summer 2026

Degree Name

Doctor of Public Health in Public Health Leadership (Dr.P.H.)

Document Type and Release Option

Dissertation (open access)

Copyright Statement / License for Reuse

Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 License.

Department

College of Public Health

Committee Chair

Joanne Chopak-Foss

Committee Member 1

Logan Cowan

Committee Member 2

Katie Mercer

Abstract

Introduction: This state-level ecological repeated cross-sectional study examined sociodemographic differences in sepsis-related Medicare hospitalizations assigned to Medicare Severity Diagnosis-Related Groups (MS-DRGs) 871 and 872 in 2019 and 2022.

Objective: The study focused on three outcomes: changes in sepsis-related Medicare discharge volume, changes in average Medicare payment per sepsis discharge, and changes in the proportion of MS-DRG 871 discharges relative to MS-DRG 872 discharges.

Methods: Publicly available Medicare inpatient hospital data and state-level demographic data were used to evaluate whether age, race, gender composition, and median household income were associated with these changes across the 50 U.S. states and the District of Columbia. Multiple linear regression models were used to assess state-level associations for each outcome.

Results: Overall, sepsis-related Medicare discharge volume declined from 2019 to 2022, while average Medicare payment and the proportion of MS-DRG 871 increased across state-level observations. The selected sociodemographic characteristics did not significantly explain changes in discharge volume after adjustment. Median household income was significantly associated with changes in average Medicare payment. For the severity distribution outcome, gender composition and race were not statistically significant after adjustment.

Discussion: Broader economic and reimbursement-related factors may influence payment variation across states. These findings indicate that discharge volume alone may not fully capture the state-level burden and financial impact of sepsis-related Medicare hospitalizations. The study highlights the importance of interpreting administrative sepsis data in relation to reimbursement policy, clinical documentation, coding practices, case mix, and state-level economic context. Future research should incorporate patient-level clinical severity, hospital characteristics, documentation practices, and COVID-19-related factors to better explain variations in sepsis utilization, payment, and severity classification.

Research Data and Supplementary Material

No

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