Association Between Medicare’s Sepsis Reporting Policy (SEP-1) and the Documentation of a Sepsis Diagnosis in the Clinical Record
Ian J. Barbash, Billie S. Davis, Melissa Saul, Rebecca Hwa, Emily B. Brant, Christopher W. Seymour, Jeremy M. Kahn- Public Health, Environmental and Occupational Health
Study Design:
Interrupted time series analysis of a retrospective, electronic health record cohort.
Objective:
To determine the association between the implementation of Medicare’s sepsis reporting measure (SEP-1) and sepsis diagnosis rates as assessed in clinical documentation.
Background:
The role of health policy in the effort to improve sepsis diagnosis remains unclear.
Patients and Methods:
Adult patients hospitalized with suspected infection and organ dysfunction within 6 hours of presentation to the emergency department, admitted to one of 11 hospitals in a multi-hospital health system from January 2013 to December 2017. Clinician-diagnosed sepsis, as reflected by the inclusion of the terms “sepsis” or “septic” in the text of clinical notes in the first two calendar days following presentation.
Results:
Among 44,074 adult patients with sepsis admitted to 11 hospitals over 5 years, the proportion with sepsis documentation was 32.2% just before the implementation of SEP-1 in the third quarter of 2015 and increased to 37.3% by the fourth quarter of 2017. Of the 9 post-SEP-1 quarters, 8 had odds ratios for a sepsis diagnosis >1 (overall range: 0.98–1.26;
Conclusions:
SEP-1 implementation was associated with modest increases in sepsis diagnosis rates, primarily among patients who did not require vasoactive medications.