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Introduction of Sepsis Performance Measure Had Little Impact

TUESDAY, April 20, 2021 — Implementation of a Medicare requirement that hospitals report on their adherence to the Severe Sepsis and Sepsis Shock Early Management Bundle (SEP-1) had a variable impact on changes in process measures, with no improvement in clinical outcomes, according to a study published online April 20 in the Annals of Internal Medicine.

Ian J. Barbash, M.D., from the University of Pittsburgh School of Medicine, and colleagues examined the effect of the onset of the SEP-1 reporting requirement in October 2015 on treatment patterns and patient outcomes. Data were included for 54,225 encounters for adults with sepsis, hospitalized through the emergency department between January 2013 and December 2017.

The researchers found that SEP-1 correlated with variable changes in process measures two years after implementation, with the greatest effect being an increase in lactate measurement within three hours of sepsis onset (absolute increase, 23.7 percent). Small increases were seen in antibiotic administration (absolute increased, 4.7 percent) and fluid administration of 30 mL/kg of body weight within three hours of sepsis onset (absolute increase, 3.4 percent). No change was observed in vasopressor administration. A small increase was seen in intensive care unit admissions (absolute increase, 2.0 percent), while no change was seen in mortality (absolute change, 0.1 percent) or discharge to home.

“Policymakers could consider revisions to the measure that simplify the components, permitting clinicians some discretion on the basis of patient characteristics, and allowing clinicians to focus on the aspects of sepsis care that most directly drive improvements in patient outcomes,” the authors write.

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