TY - JOUR
T1 - The Impact of Centers for Medicare & Medicaid Services SEP-1 Core Measure Implementation on Antibacterial Utilization
T2 - A Retrospective Multicenter Longitudinal Cohort Study With Interrupted Time-Series Analysis
AU - Anderson, Deverick J.
AU - Moehring, Rebekah W.
AU - Parish, Alice
AU - David, Michael Z.
AU - Hsueh, Kevin
AU - Cressman, Leigh
AU - Tolomeo, Pam
AU - Habrock-Bach, Tracey
AU - Hill, Cherie L.
AU - Ryan, Matthew
AU - O'brien, Cara
AU - Lokhnygina, Yuliya
AU - Dodds Ashley, Elizabeth
N1 - Funding Information:
Potential conflicts of interest. D. J. A reports receiving additional grant funding from the National Institute of Allergy and Infectious Diseases, National Institutes of Health, and the Agency for Healthcare Research and Quality for grants unrelated to this study and receiving royalties for authorship from UpToDate Online. All other authors report no potential conflicts. All authors have submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Conflicts that the editors consider relevant to the content of the manuscript have been disclosed.
Publisher Copyright:
© 2021 The Author(s). Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved.
PY - 2022/8/1
Y1 - 2022/8/1
N2 - Background: The impact of the US Centers for Medicare & Medicaid Services (CMS) Severe Sepsis and Septic Shock: Management Bundle (SEP-1) core measure on overall antibacterial utilization is unknown. Methods: We performed a retrospective multicenter longitudinal cohort study with interrupted time-series analysis to determine the impact of SEP-1 implementation on antibacterial utilization and patient outcomes. All adult patients admitted to 26 hospitals between 1 October 2014 and 30 September 2015 (SEP-1 preparation period) and between 1 November 2015 and 31 October 2016 (SEP-1 implementation period) were evaluated for inclusion. The primary outcome was total antibacterial utilization, measured as days of therapy (DOT) per 1000 patient-days. Results: The study cohort included 701 055 eligible patient admissions and 4.2 million patient-days. Overall antibacterial utilization increased 2% each month during SEP-1 preparation (relative rate [RR], 1.02 per month [95% confidence interval {CI}, 1.00-1.04]; P =. 02). Cumulatively, the mean monthly DOT per 1000 patient-days increased 24.4% (95% CI, 18.0%-38.8%) over the entire study period (October 2014-October 2016). The rate of sepsis diagnosis/1000 patients increased 2% each month during SEP-1 preparation (RR, 1.02 per month [95% CI, 1.00-1.04]; P =. 04). The rate of all-cause mortality rate per 1000 patients decreased during the study period (RR for SEP-1 preparation, 0.95 [95% CI,. 92-.98; P =. 001]; RR for SEP-1 implementation,. 98 [.97-1.00; P =. 01]). Cumulatively, the monthly mean all-cause mortality rate/1000 patients declined 38.5% (95% CI, 25.9%-48.0%) over the study period. Conclusions: Announcement and implementation of the CMS SEP-1 process measure was associated with increased diagnosis of sepsis and antibacterial utilization and decreased mortality rate among hospitalized patients.
AB - Background: The impact of the US Centers for Medicare & Medicaid Services (CMS) Severe Sepsis and Septic Shock: Management Bundle (SEP-1) core measure on overall antibacterial utilization is unknown. Methods: We performed a retrospective multicenter longitudinal cohort study with interrupted time-series analysis to determine the impact of SEP-1 implementation on antibacterial utilization and patient outcomes. All adult patients admitted to 26 hospitals between 1 October 2014 and 30 September 2015 (SEP-1 preparation period) and between 1 November 2015 and 31 October 2016 (SEP-1 implementation period) were evaluated for inclusion. The primary outcome was total antibacterial utilization, measured as days of therapy (DOT) per 1000 patient-days. Results: The study cohort included 701 055 eligible patient admissions and 4.2 million patient-days. Overall antibacterial utilization increased 2% each month during SEP-1 preparation (relative rate [RR], 1.02 per month [95% confidence interval {CI}, 1.00-1.04]; P =. 02). Cumulatively, the mean monthly DOT per 1000 patient-days increased 24.4% (95% CI, 18.0%-38.8%) over the entire study period (October 2014-October 2016). The rate of sepsis diagnosis/1000 patients increased 2% each month during SEP-1 preparation (RR, 1.02 per month [95% CI, 1.00-1.04]; P =. 04). The rate of all-cause mortality rate per 1000 patients decreased during the study period (RR for SEP-1 preparation, 0.95 [95% CI,. 92-.98; P =. 001]; RR for SEP-1 implementation,. 98 [.97-1.00; P =. 01]). Cumulatively, the monthly mean all-cause mortality rate/1000 patients declined 38.5% (95% CI, 25.9%-48.0%) over the study period. Conclusions: Announcement and implementation of the CMS SEP-1 process measure was associated with increased diagnosis of sepsis and antibacterial utilization and decreased mortality rate among hospitalized patients.
KW - antimicrobial utilization
KW - patient outcomes
KW - sepsis
UR - http://www.scopus.com/inward/record.url?scp=85135346818&partnerID=8YFLogxK
U2 - 10.1093/cid/ciab937
DO - 10.1093/cid/ciab937
M3 - Article
C2 - 34739080
AN - SCOPUS:85135346818
SN - 1058-4838
VL - 75
SP - 503
EP - 511
JO - Clinical Infectious Diseases
JF - Clinical Infectious Diseases
IS - 3
ER -