Driving blind: instituting SEP-1 without high quality outcomes data.

Journal of Thoracic Disease
Jeffrey WangPeter Q Eichacker

Abstract

In 2015, the Centers for Medicare and Medicaid Services (CMS) instituted an all-or-none sepsis performance measure bundle (SEP-1) to promote high-quality, cost-effective care. Systematic reviews demonstrated only low-quality evidence supporting most of SEP-1's interventions. CMS has removed some but not all of these unproven components. The current SEP-1 version requires patients with suspected sepsis have a lactate level, blood cultures, broad-spectrum antibiotics and, if hypotensive, a fixed 30 mL/kg fluid infusion within 3 hours, and a repeat lactate if initially elevated within 6 hours. Experts have continued to raise concerns that SEP-1 remains overly prescriptive, lacks a sound scientific basis and presents risks (overuse of antibiotics and inappropriate fluids not titrated to need). To incentivize compliance with SEP-1, CMS now publicly publishes how often hospitals complete all interventions in individual patients. However, compliance measured across hospitals (5 studies, 48-2,851 hospitals) or patients (three studies, 110-851 patients) has been low (approximately 50%) which is not surprising given SEP-1's lack of scientific basis. The largest observational study (1,738 patients) reporting survival rates employing SEP-1...Continue Reading

Citations

Sep 15, 2020·Critical Care Medicine·Mitchell M Levy
Nov 4, 2020·Expert Review of Anti-infective Therapy·Nicholas HemingDjillali Annane
Apr 26, 2020·Critical Care Medicine·Irene Cortés-PuchCharles Natanson
Nov 25, 2020·Surgical Infections·Christopher A GuidryRobert D Winfield
Feb 16, 2021·Annals of Internal Medicine·Harry PeledShelley Schoepflin Sanders
Oct 16, 2020·Chest·Dipayan ChaudhuriBram Rochwerg
Aug 5, 2021·Academic Emergency Medicine : Official Journal of the Society for Academic Emergency Medicine·Christopher M Fung, William J Meurer
Aug 12, 2021·Scientific Reports·Maja KopczynskaUNKNOWN Welsh Digital Data Collection Platform collaborators
Aug 4, 2021·Critical Care Medicine·R Phillip DellingerSean R Townsend

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