The Impact of Centers for Medicare & Medicaid Services SEP-1 Core Measure Implementation on Antibacterial Utilization: A Retrospective Multicenter Longitudinal Cohort Study With Interrupted Time-Series Analysis

Deverick J. Anderson, Rebekah W. Moehring, Alice Parish, Michael Z. David, Kevin Hsueh, Leigh Cressman, Pam Tolomeo, Tracey Habrock-Bach, Cherie L. Hill, Matthew Ryan, Cara O'brien, Yuliya Lokhnygina, Elizabeth Dodds Ashley

Research output: Contribution to journalArticlepeer-review

8 Scopus citations

Abstract

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.

Original languageEnglish
Pages (from-to)503-511
Number of pages9
JournalClinical Infectious Diseases
Volume75
Issue number3
DOIs
StatePublished - Aug 1 2022

Keywords

  • antimicrobial utilization
  • patient outcomes
  • sepsis

Fingerprint

Dive into the research topics of 'The Impact of Centers for Medicare & Medicaid Services SEP-1 Core Measure Implementation on Antibacterial Utilization: A Retrospective Multicenter Longitudinal Cohort Study With Interrupted Time-Series Analysis'. Together they form a unique fingerprint.

Cite this