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National Performance on the Medicare SEP-1 Sepsis Quality Measure

Barbash, Ian J., MD, MS1,2; Davis, Billie, PhD2,3; Kahn, Jeremy M., MD, MS1,2,3

doi: 10.1097/CCM.0000000000003613
Clinical Investigation: PDF Only

Objectives: The Centers for Medicare and Medicaid Services requires hospitals to report compliance with a sepsis treatment bundle as part of its Inpatient Quality Reporting Program. We used recently released data from this program to characterize national performance on the sepsis measure, known as SEP-1.

Design: Cross-sectional study of United States hospitals participating in the Centers for Medicare and Medicaid Services Hospital Inpatient Quality Reporting Program linked to Centers for Medicare and Medicaid Services’ Healthcare Cost Reporting Information System.

Setting: General, short-stay, acute-care hospitals in the United States.

Measurements and Main Results: We examined the hospital factors associated with reporting SEP-1 data, the hospital factors associated with performance on the SEP-1 measure, and the relationship between SEP-1 performance and performance on other quality measures related to time-sensitive medical conditions. A total of 3,283 hospitals were eligible for the analysis, of which 2,851 (86.8%) reported SEP-1 performance data. SEP-1 reporting was more common in larger, nonprofit hospitals. The most common reason for nonreporting was an inadequate case volume. Among hospitals reporting SEP-1 performance data, overall bundle compliance was generally low, but it varied widely across hospitals (mean and SD: 48.9% ± 19.4%). Compared with hospitals with worse SEP-1 performance, hospitals with better SEP-1 performance tended to be smaller, for-profit, nonteaching, and with intermediate-sized ICUs. Better hospital performance on SEP-1 was associated with higher rates of timely head CT interpretation for stroke patients (rho = 0.16; p < 0.001), more frequent aspirin administration for patients with chest pain or heart attacks (rho = 0.24; p < 0.001) and shorter median time to electrocardiogram for patients with chest pain (rho = –0.12; p < 0.001).

Conclusions: The majority of eligible hospitals reported SEP-1 data, and overall bundle compliance was highly variable. SEP-1 performance was associated with structural hospital characteristics and performance on other measures of hospital quality, providing preliminary support for SEP-1 performance as a marker of timely hospital sepsis care.

1Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA.

2CRISMA Center, Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA.

3Department of Health Policy & Management, University of Pittsburgh Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA.

Supported, in part, by Agency for Healthcare Research and Quality (to Dr. Barbash, K08HS025455), National Institutes of Health (to Dr. Kahn, K24HL133444).

Dr. Barbash received support for article research from the Agency for Healthcare Research and Quality. Dr. Kahn’s institution received funding from the NIH, and he received support for article research from the NIH. Dr. Davis has disclosed that she does not have any potential conflicts of interest.

For information regarding this article, E-mail: barbashij@upmc.edu

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