Treatment patterns and clinical outcomes after the introduction of the Medicare Sepsis Performance measure (SEP-1).
Open accessAbstract
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.
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Several studies examining the period shortly before and after SEP-1 was introduced in 2015 demonstrated significant increases in broad-spectrum and total antibiotic use in US hospitals without corresponding decreases in sepsis-associated mortality.
“Several studies examining the period shortly before and after SEP-1 was introduced in 2015 demonstrated significant increases in broad-spectrum and total antibiotic use in US hospitals without corresponding decreases in sepsis-associated mortality.”
From Trends in empiric broad-Spectrum antibiotic use for suspected community-onset Sepsis in US hospitals (2024) · cites this paper as [20]
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- Authors
- Barbash, I. J., Davis, B. S., Yabes, J. G., Seymour, C. W., Angus, D. C., & Kahn, J. M.
- Affiliations
- University of Pittsburgh (US)
- Venue
- Annals of Internal Medicine
- Publisher
- American College of Physicians
- Published
- 2021-07
- Volume
- 174
- Issue
- 7
- Pages
- 927-935
- ISSN
- 0003-4819 (ISSN-L)
- 1539-3704
- PMC
- PMC8844885
- OpenAlex
- W3154702719
- Cited by
- 65
- References
- 25
- Citations by year
- 2026: 11 · 2025: 11 · 2024: 12 · 2023: 8 · 2022: 13 · 2021: 9 · 2020: 1
- FWCI
- 7.57
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Annals of Internal Medicine (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institutes of Health (K24HL133444)
- Agency for Healthcare Research and Quality (K08HS025455)
- Topics
- Health Sciences › Medicine › Epidemiology › Sepsis Diagnosis and Treatment
- Health Sciences › Health Professions › Health Information Management › Healthcare Quality and Management
- Health Sciences › Medicine › Nephrology › Acute Kidney Injury Research
- Keywords
- sepsis, septic shock, hospital quality reporting, sepsis bundle, lactate measurement, fluid resuscitation, antibiotic administration, vasopressors, intensive care unit admission, in-hospital mortality, home discharge, treatment patterns, quality improvement, integrated health system, sepsis mortality
- MeSH terms
- Aged, Aged, 80 and over, Anti-Bacterial Agents, Cross-Sectional Studies, Female, Fluid Therapy, Medicare, Humans, Longitudinal Studies, Male, Middle Aged, United States, Vasoconstrictor Agents, Outcome Assessment, Health Care, Practice Guidelines as Topic, Sepsis, Mandatory Reporting, Lactic Acid, Guideline Adherence, Quality Improvement, Patient Care Bundles
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