Critical Care: Original Investigations in Critical Care |

Map the Gap: A Novel Approach Using Regional Mapping to Determine the State of the Critical Care Physician Workforce With Regards to Sepsis Mortality FREE TO VIEW

Aditya Shah, MD; Brian Wolf, MD; Armand Krikorian, MD; Adam Treitman, MD
Author and Funding Information

Advocate Christ Medical Center, Oak Lawn, IL

Copyright 2016, American College of Chest Physicians. All Rights Reserved.

Chest. 2016;150(4_S):344A. doi:10.1016/j.chest.2016.08.357
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SESSION TITLE: Original Investigations in Critical Care

SESSION TYPE: Original Investigation Slide

PRESENTED ON: Sunday, October 23, 2016 at 04:30 PM - 05:30 PM

PURPOSE: Sepsis is the body’s overwhelming and life-threatening response to an infection, which can lead to tissue damage, organ failure, and death. It is also associated with a significant financial impact on healthcare systems. As sepsis is known as a prominent cause of deaths in the United States (US), a regional state wise incidence of this disease could provide additional information and insight with regards to its geographical distribution. Over the past decade, reimbursement and lack of trained physicians have been cited as major challenges in the battle against sepsis.

METHODS: We conducted a descriptive analysis using mortality data from the National Center for Health Statistics’ (NCHS), Compressed Mortality File (CMF), which contains descriptive data on the age, race, sex, year and causes of all deaths in the US. We used this data set as it is the only one which aggregates US death incidence with regards to geographical distribution. We defined sepsis death as death attributed to an infection. The location of current Critical Care fellowships was obtained from the National Residency Matching Program (NRMP) public data. We mapped this data using Google fusion tables and studied them in relation to deaths attributed to infection in the continental US, after running algorithms through the NCHS software, selecting deaths from infections, in age groups 20 years and older, in all races, and both sexes, with state wise charting of the data.

RESULTS: A total of 150 Critical Care fellowship programs were identified. Our results indicate that Critical Care fellowship programs tend to be more concentrated in the Northeast and metropolitan areas in the Western regions of the US, which parallel similar patterns noted in other specialties. Survival rates for sepsis were also noted to be higher in these locations. Several previous studies have indicated that physicians often tend to practice in geographic areas close to their training sites. A cluster extending from the Southeastern to the mid-Atlantic US encompassed states with the highest sepsis mortality, whereas relatively, the west coast had a significantly lower crude mortality rate as compared to the south eastern regions.

CONCLUSIONS: The use of this novel mapping approach to assess the Critical Care physician workforce has the potential of providing real time data regarding their geographical spread.

CLINICAL IMPLICATIONS: The discrepancies between supply and demand could be addressed by targeted rebalancing interventions that may include additional fellowship spots, in Critical Care Medicine, in ‘underserved’ areas as well as financial and practice incentives.

DISCLOSURE: The following authors have nothing to disclose: Aditya Shah, Brian Wolf, Armand Krikorian, Adam Treitman

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