Hospital Perceptions of Medicare's Sepsis Quality Reporting Initiative

Abstract

BACKGROUND In October 2015, the Centers for Medicare and Medicaid Services (CMS) implemented the Sepsis CMS Core Measure (SEP-1) program, requiring hospitals to report data on the quality of care for their patients with sepsis. OBJECTIVE We sought to understand hospital perceptions of and responses to the SEP-1 program. DESIGN A thematic content analysis of semistructured interviews with hospital quality officials. SETTING A stratified random sample of short-stay, nonfederal, general acute care hospitals in the United States. SUBJECTS Hospital quality officers, including nurses and physicians. INTERVENTION None. MEASUREMENTS We completed 29 interviews before reaching content saturation. RESULTS Hospitals reported a variety of actions in response to SEP-1, including new efforts to collect data, improve sepsis diagnosis and treatment, and manage clinicians’ attitudes toward SEP-1. These efforts frequently required dedicated resources to meet the program’s requirements for treatment and documentation, which were thought to be complex and not consistently linked to patient-centered outcomes. Most respondents felt that SEP-1 was likely to improve sepsis outcomes. At the same time, they described specific changes that could improve its effectiveness, including allowing hospitals to focus on the treatment processes most directly associated with improved patient outcomes and better aligning the measure’s sepsis definitions with current clinical definitions. CONCLUSIONS Hospitals are responding to the SEP-1 program across a number of domains and in ways that consistently require dedicated resources. Hospitals are interested in further revisions to the program to alleviate the burden of the reporting requirements and help them optimize the effectiveness of their investments in quality-improvement efforts.

A systematic review and meta-synthesis of policy intervention characteristics that influence the implementation of government-directed policy in the hospital setting: implications for infection prevention and control

“…Policy intervention involved activities undertaken to align policy changes with clinical goals, priorities and patient outcomes Amin et al, 2014;Back et al, 2017;Barbash et al, 2017;Cherlin et al, 2017;Coleman et al, 2007;Duckers et al, 2009b;Gasparini et al, 2015;Iorio et al, 2016;Jurkowski et al, 2016;Ketko et al, 2015;Lanese, 2016;McClain et al, 2017;McHugh et al, 2011;Morrow et al, 2012;Padula et al, 2015;Russ et al, 2015;Sautter et al, 2007;Som, 2007;Stone et al, 2015;Wald et al, 2012;Weeks et al, 2014;Wiig et al, 2013;Yelland et al, 2017;Yu et al, 2...…”

Variability in determining sepsis time zero and bundle compliance rates for the centers for medicare and medicaid services SEP-1 measure

“…1 Hospitals are now devoting substantial resources to measuring and improving SEP-1 adherence, which requires all bundle components be met to "pass." 2,3 SEP-1 bundle adherence is measured relative to sepsis "time zero," defined as the first point at which there is documentation of suspected or confirmed infection, 2 or more systemic inflammatory response syndrome criteria, and one or more organ dysfunction criteria within a 6-hour window. 1 Time zero is also triggered if a clinician explicitly documents severe sepsis or septic shock.…”

“…In October 2015, the Centers for Medicare and Medicaid Services (CMS) implemented the “SEP-1” sepsis core measure requiring US hospitals to report compliance with 3- and 6-hour bundles of care for patients with severe sepsis or septic shock 1 . Hospitals are now devoting substantial resources to measuring and improving SEP-1 adherence, which requires all bundle components be met to “pass.” 2 , 3 …”

Keeping It Simple in Sepsis Measures

“…Sepsis went from being defined as the presence of infection with concomitant systemic inflammatory response syndrome (sepsis), organ dysfunction (severe sepsis), and/or shock, 15 to being defined as a dysregulated response to infection resulting in life-threatening organ dysfunction (sepsis) and/or fluid-resistant hypotension requiring vasopressors and lactate greater than 2 mmol/L. 16 As the study by Barbash et al 17 in this issue clearly outlines, conflicting definitions of “sepsis” have left clinicians confused as to whom the SEP-1 measure should apply. At the same time, results of 3 large, international, randomized trials investigating the efficacy of EGDT were published, providing strong evidence that EGDT did not provide improved patient outcomes over usual care.…”