Study questions sepsis treatment measure's impact on outcomes

A recent study from the Center for Sepsis Epidemiology and Prevention Studies at Harvard Pilgrim Health Care Institute questions the effectiveness of a sepsis quality measure known as the SEP-1 bundle. This measure was introduced by the Centers for Medicare and Medicaid Services (CMS) to ensure timely treatment for sepsis, a severe infection-related condition. SEP-1 requires healthcare providers to perform specific actions within three hours of detecting sepsis symptoms. These include tasks like measuring lactate levels, taking blood samples, and administering antibiotics. Initially a pay-for-reporting initiative, SEP-1 has shifted to a pay-for-performance model, raising concerns about its strict protocol. Research indicated that while CMS claims that SEP-1 compliant treatment leads to lower death rates, it is unclear if this is due to the SEP-1 bundle itself or simply because these patients are less critically ill compared to those who do not receive compliant care. In the study published in JAMA Network Open, researchers analyzed the medical records of 590 sepsis patients from four hospitals between 2019 and 2022. They compared patients who did and didn’t receive SEP-1 compliant care, focusing on details often ignored in other studies, such as patients' home language and other health issues. Findings showed that those receiving SEP-1 compliant care generally faced simpler health scenarios. In contrast, non-compliant patients often had more complex medical issues and required urgent procedures. After adjusting for these complexities, the study found no significant link between SEP-1 compliance and reduced mortality, challenging the belief that following the SEP-1 bundle improves survival. Lead author Dr. Chanu Rhee pointed out that non-compliance doesn’t indicate poor care but reflects the complexities of individual patient cases. The results raise doubts about CMS’s decision to make SEP-1 a pay-for-performance measure, suggesting it may not lead to better outcomes for sepsis patients. Experts, including Dr. Michael Klompas, suggest a shift away from rigid process measures like SEP-1 and advocate for quality measures that enhance the entire range of sepsis care. This includes early recognition and recovery while allowing flexibility based on medical judgment.