{"doi":"10.7326/m20-5043","title":"Treatment Patterns and Clinical Outcomes After the Introduction of the Medicare Sepsis Performance Measure (SEP-1)","abstract":"Background: Medicare requires that hospitals report on their adherence to the Severe Sepsis and Septic Shock Early Management Bundle (SEP-1). Objective: To evaluate the effect of SEP-1 on treatment patterns and patient outcomes. Design: Longitudinal study of hospitals using repeated cross-sectional cohorts of patients. Setting: 11 hospitals within an integrated health system. Patients: 54 225 encounters between January 2013 and December 2017 for adults with sepsis who were hospitalized through the emergency department. Intervention: Onset of the SEP-1 reporting requirement in October 2015. Measurements: 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. Results: 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. Limitation: Data are from a single health system. Conclusion: 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. Primary Funding Source: Agency for Healthcare Research and Quality.","journal":"Annals of Internal Medicine","year":2021,"id":161759,"datarank":0.0,"base_score":0.0,"endowment":0.0,"self_citation_contribution":0.0,"citation_network_contribution":0.0,"self_endowment_contribution":0.0,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":59,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.8945,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2021-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":648546,"name":"Billie S. Davis","orcid":"0000-0002-6342-4244","position":1,"is_corresponding":false},{"id":385881,"name":"Jonathan G. Yabes","orcid":"0000-0002-9406-2362","position":2,"is_corresponding":false},{"id":677683,"name":"Chris Seymour","orcid":null,"position":3,"is_corresponding":false},{"id":3838,"name":"Derek C. Angus","orcid":"0000-0002-7026-5181","position":4,"is_corresponding":false},{"id":369068,"name":"Jeremy M. Kahn","orcid":"0000-0001-9688-5576","position":5,"is_corresponding":false},{"id":313764,"name":"Ian J. Barbash","orcid":"0000-0002-9840-0576","position":0,"is_corresponding":true}],"reference_count":26,"raw_metadata":null,"created_at":"2026-07-18T23:44:56.409311Z","pmid":"33872042","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}