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Treatment Patterns and Clinical Outcomes After the Introduction of the Medicare Sepsis Performance Measure (SEP-1)
- Source :
- Annals of Internal Medicine. 174:927-935
- Publication Year :
- 2021
- Publisher :
- American College of Physicians, 2021.
-
Abstract
- BACKGROUND Medicare requires that hospitals report on their adherence to the Severe Sepsis and Septic Shock Early Management Bundle (SEP-1). OBJECTIVE To evaluate the effect of SEP-1 on treatment patterns and patient outcomes. DESIGN Longitudinal study of hospitals using repeated cross-sectional cohorts of patients. SETTING 11 hospitals within an integrated health system. PATIENTS 54 225 encounters between January 2013 and December 2017 for adults with sepsis who were hospitalized through the emergency department. INTERVENTION Onset of the SEP-1 reporting requirement in October 2015. MEASUREMENTS Changes in SEP-1-targeted processes, including antibiotic administration, lactate measurement, and fluid administration at 3 hours from sepsis onset; repeated lactate and vasopressor administration for hypotension within 6 hours of sepsis onset; and sepsis outcomes, including risk-adjusted intensive care unit (ICU) admission, in-hospital mortality, and home discharge among survivors. RESULTS Two years after its implementation, SEP-1 was associated with variable changes in process measures, with the greatest effect being an increase in lactate measurement within 3 hours of sepsis onset (absolute increase, 23.7 percentage points [95% CI, 20.7 to 26.7 percentage points]; P < 0.001). There were small increases in antibiotic administration (absolute increase, 4.7 percentage points [CI, 1.9 to 7.6 percentage points]; P = 0.001) and fluid administration of 30 mL/kg of body weight within 3 hours of sepsis onset (absolute increase, 3.4 percentage points [CI, 1.5 to 5.2 percentage points]; P < 0.001). There was no change in vasopressor administration. There was a small increase in ICU admissions (absolute increase, 2.0 percentage points [CI, 0 to 4.0 percentage points]; P = 0.055) and no changes in mortality (absolute change, 0.1 percentage points [CI, -0.9 to 1.1 percentage points]; P = 0.87) or discharge to home. LIMITATION Data are from a single health system. CONCLUSION Implementation of the SEP-1 mandatory reporting program was associated with variable changes in process measures, without improvements in clinical outcomes. Revising the measure may optimize its future effect. PRIMARY FUNDING SOURCE Agency for Healthcare Research and Quality.
- Subjects :
- Male
Fluid administration
Longitudinal study
medicine.medical_specialty
Lactate measurement
Medicare
law.invention
Sepsis
law
Outcome Assessment, Health Care
Internal Medicine
medicine
Humans
Vasoconstrictor Agents
Lactic Acid
Longitudinal Studies
Aged
Aged, 80 and over
Septic shock
business.industry
Percentage point
General Medicine
Emergency department
Mandatory Reporting
Middle Aged
medicine.disease
Quality Improvement
Intensive care unit
United States
Anti-Bacterial Agents
Cross-Sectional Studies
Practice Guidelines as Topic
Emergency medicine
Fluid Therapy
Female
Guideline Adherence
business
Patient Care Bundles
Subjects
Details
- ISSN :
- 15393704 and 00034819
- Volume :
- 174
- Database :
- OpenAIRE
- Journal :
- Annals of Internal Medicine
- Accession number :
- edsair.doi.dedup.....a1247bb08d8d8ac38bea923ca9b4f34d
- Full Text :
- https://doi.org/10.7326/m20-5043