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Multicenter Study
. 2018 Oct;46(10):1585-1591.
doi: 10.1097/CCM.0000000000003261.

Compliance With the National SEP-1 Quality Measure and Association With Sepsis Outcomes: A Multicenter Retrospective Cohort Study

Chanu Rhee  1   2 , Michael R Filbin  3 , Anthony F Massaro  2 , Amy L Bulger  4 , Donna McEachern  4 , Kathleen A Tobin  5 , Barrett T Kitch  6 , Bert Thurlo-Walsh  7 , Aran Kadar  8 , Alexandra Koffman  9 , Anupam Pande  10 , Yasir Hamad  10 , David K Warren  10 , Travis M Jones  11 , Cara O'Brien  12 , Deverick J Anderson  11 , Rui Wang  1 , Michael Klompas  1   2 ; Centers for Disease Control and Prevention (CDC) Prevention Epicenters Program
Affiliations
Multicenter Study

Compliance With the National SEP-1 Quality Measure and Association With Sepsis Outcomes: A Multicenter Retrospective Cohort Study

Chanu Rhee et al. Crit Care Med. 2018 Oct.

Abstract

Objectives: Many septic patients receive care that fails the Centers for Medicare and Medicaid Services' SEP-1 measure, but it is unclear whether this reflects meaningful lapses in care, differences in clinical characteristics, or excessive rigidity of the "all-or-nothing" measure. We compared outcomes in cases that passed versus failed SEP-1 during the first 2 years after the measure was implemented.

Design: Retrospective cohort study.

Setting: Seven U.S. hospitals.

Patients: Adult patients included in SEP-1 reporting between October 2015 and September 2017.

Interventions: None.

Measurements and main results: Of 851 sepsis cases in the cohort, 281 (33%) passed SEP-1 and 570 (67%) failed. SEP-1 failures had higher rates of septic shock (20% vs 9%; p < 0.001), hospital-onset sepsis (11% vs 4%; p = 0.001), and vague presenting symptoms (46% vs 30%; p < 0.001). The most common reasons for failure were omission of 3- and 6-hour lactate measurements (228/570 failures, 40%). Only 86 of 570 failures (15.1%) had greater than 3-hour delays until broad-spectrum antibiotics. Cases that failed SEP-1 had higher in-hospital mortality rates (18.4% vs 11.0%; odds ratio, 1.82; 95% CI, 1.19-2.80; p = 0.006), but this association was no longer significant after adjusting for differences in clinical characteristics and severity of illness (adjusted odds ratio, 1.36; 95% CI, 0.85-2.18; p = 0.205). Delays of greater than 3 hours until antibiotics were significantly associated with death (adjusted odds ratio, 1.94; 95% CI, 1.04-3.62; p = 0.038), whereas failing SEP-1 for any other reason was not (adjusted odds ratio, 1.10; 95% CI, 0.70-1.72; p = 0.674).

Conclusions: Crude mortality rates were higher in sepsis cases that failed versus passed SEP-1, but there was no difference after adjusting for clinical characteristics and severity of illness. Delays in antibiotic administration were associated with higher mortality but only accounted for a small fraction of SEP-1 failures. SEP-1 may not clearly differentiate between high- and low-quality care, and detailed risk adjustment is necessary to properly interpret associations between SEP-1 compliance and mortality.

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Conflict of interest statement

Potential conflicts of interest: None of the authors have any conflicts to disclose.

Copyright form disclosure: The remaining authors have disclosed that they do not have any potential conflicts of interest.

Figures

Figure 1
Figure 1
Flowchart for study cohort derivation and exclusions
See this image and copyright information in PMC

Comment in

References

    1. QualityNet. Inpatient Hospitals Specifications Manual. https://www.qualitynet.org.
    1. The Clinician Perspective on Sepsis Care: Early Management Bundle for Severe Sepsis/Septic Shock. 2016 Nov 16; http://www.qualityreportingcenter.com/wp-content/uploads/2016/12/IQR_Pre....
    1. Klompas M, Rhee C. The CMS Sepsis Mandate: Right Disease, Wrong Measure. Ann Intern Med. 2016;165(7):517–518. - PubMed
    1. Aaronson EL, Filbin MR, Brown DF, et al. New Mandated Centers for Medicare and Medicaid Services Requirements for Sepsis Reporting: Caution from the Field. J Emerg Med. 2017;52(1):109–116. - PubMed
    1. Venkatesh AK, Slesinger T, Whittle J, et al. Preliminary Performance on the New CMS Sepsis-1 National Quality Measure: Early Insights From the Emergency Quality Network (E-QUAL) Ann Emerg Med. 2018;71(1):10–15 e11. - PubMed

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