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Crit Care Med. 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.

Author information

1
Department of Population Medicine, Harvard Medical School/Harvard Pilgrim Health Care Institute, Boston, MA.
2
Department of Medicine, Brigham and Women's Hospital, Boston, MA.
3
Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA.
4
Department of Quality and Safety, Brigham and Women's Hospital, Boston, MA.
5
Lawrence Center for Quality and Safety, Massachusetts General Hospital, Boston, MA.
6
Department of Medicine, North Shore Medical Center, Salem, MA.
7
Office of Quality, Patient Safety & Experience, Newton-Wellesley Hospital, Newton, MA.
8
Department of Medicine, Newton-Wellesley Hospital, Newton, MA.
9
Department of Quality, Brigham and Women's Faulkner Hospital, Boston, MA.
10
Department of Medicine, Washington University School of Medicine, St. Louis, MO.
11
Duke Center for Antimicrobial Stewardship and Infection Prevention, Durham, NC.
12
Department of Medicine, Duke University Medical Center, Durham, NC.

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.

Comment in

PMID:
30015667
PMCID:
PMC6138564
[Available on 2019-10-01]
DOI:
10.1097/CCM.0000000000003261

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