Treatment Patterns and Clinical Outcomes After the Introduction of the Medicare Sepsis Performance Measure (SEP-1).
Treatment Patterns and Clinical Outcomes After the Introduction of the Medicare Sepsis Performance Measure (SEP-1).
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DOI：
10.7326/m20-5043
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发表时间：
2021-07
影响因子：
39.2
通讯作者：
Kahn JM
中科院分区：
文献类型：
--
作者：
Barbash IJ;Davis BS;Yabes JG;Seymour CW;Angus DC;Kahn JM
医疗保险要求医院报告他们对严重脓毒症和脓毒性休克早期管理捆绑包（SEP-1）的遵守情况。评价SEP-1对治疗模式和患者结局的影响。使用患者重复横断面队列的医院纵向研究。11家医院纳入综合卫生系统。在2013年1月至2017年12月期间，有54225例败血症成人通过急诊科住院。SEP-1报告要求于2015年10月开始。SEP-1靶向过程的变化，包括脓毒症发作后3小时的抗生素给药、乳酸盐测量和液体给药;脓毒症发作后6小时内因低血压而重复给予乳酸盐和血管加压剂;以及脓毒症结局，包括经风险调整的重症监护室（ICU）入院、院内死亡率和幸存者出院。实施2年后，SEP-1与过程测量的变量变化相关，最大影响是脓毒症发作3小时内乳酸测量值增加（绝对增加，23.7个百分点[95% CI，20.7至26.7个百分点]; P < 0.001）。脓毒症发作3小时内抗生素给药（绝对增加，4.7个百分点[CI，1.9至7.6个百分点]; P = 0.001）和30 mL/kg体重的液体给药（绝对增加，3.4个百分点[CI，1.5至5.2个百分点]; P < 0.001）略有增加。血管加压药给药无变化。ICU入院率略有增加（绝对增加，2.0个百分点[CI，0 - 4.0个百分点]; P = 0.055），死亡率无变化（绝对变化，0.1个百分点[CI，-0.9至1.1个百分点]; P = 0.87）或出院回家。数据来自单一卫生系统。SEP-1强制性报告计划的实施与过程测量的可变变化相关，而临床结局没有改善。修改这项措施可能会使其今后的效果更好。卫生保健研究和质量机构。
Medicare requires that hospitals report on their adherence to the Severe Sepsis and Septic Shock Early Management Bundle (SEP-1). To evaluate the effect of SEP-1 on treatment patterns and patient outcomes. Longitudinal study of hospitals using repeated cross-sectional cohorts of patients. 11 hospitals within an integrated health system. 54 225 encounters between January 2013 and December 2017 for adults with sepsis who were hospitalized through the emergency department. Onset of the SEP-1 reporting requirement in October 2015. 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. 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. Data are from a single health system. 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. Agency for Healthcare Research and Quality.