• Sean R Townsend, Gary S Phillips, Reena Duseja, Lemeneh Tefera, Derek Cruikshank, Robert Dickerson, NguyenH BryantHBDivision of Pulmonary, Critical Care, Hyperbaric, Allergy and Sleep Medicine, Loma Linda University, Loma Linda, CA., Christa A Schorr, Mitchell M Levy, R Phillip Dellinger, William A Conway, Warren S Browner, and Emanuel P Rivers.
• Division of Pulmonary, Critical Care Medicine, California Pacific Medical Center, San Francisco, CA; Department of Medicine, University of California San Francisco School of Medicine, San Francisco, CA. Electronic address: townsesr@sutterhealth.org.
• Chest. 2022 Feb 1; 161 (2): 392-406.

BackgroundUS hospitals have reported compliance with the SEP-1 quality measure to Medicare since 2015. Finding an association between compliance and outcomes is essential to gauge measure effectiveness.Research QuestionWhat is the association between compliance with SEP-1 and 30-day mortality among Medicare beneficiaries?Study Design And MethodsStudying patient-level data reported to Medicare by 3,241 hospitals from October 1, 2015, to March 31, 2017, we used propensity score matching and a hierarchical general linear model (HGLM) to estimate the treatment effects associated with compliance with SEP-1. Compliance was defined as completion of all qualifying SEP-1 elements including lactate measurements, blood culture collection, broad-spectrum antibiotic administration, 30 mL/kg crystalloid fluid administration, application of vasopressors, and patient reassessment. The primary outcome was a change in 30-day mortality. Secondary outcomes included changes in length of stay.ResultsWe completed two matches to evaluate population-level treatment effects. In standard match, 122,870 patients whose care was compliant were matched with the same number whose care was noncompliant. Compliance was associated with a reduction in 30-day mortality (21.81% vs 27.48%, respectively), yielding an absolute risk reduction (ARR) of 5.67% (95% CI, 5.33-6.00; P < .001). In stringent match, 107,016 patients whose care was compliant were matched with the same number whose care was noncompliant. Compliance was associated with a reduction in 30-day mortality (22.22% vs 26.28%, respectively), yielding an ARR of 4.06% (95% CI, 3.70-4.41; P < .001). At the subject level, our HGLM found compliance associated with lower 30-day risk-adjusted mortality (adjusted conditional OR, 0.829; 95% CI, 0.812-0.846; P < .001). Multiple elements correlated with lower mortality. Median length of stay was shorter among cases whose care was compliant (5 vs 6 days; interquartile range, 3-9 vs 4-10, respectively; P < .001).InterpretationCompliance with SEP-1 was associated with lower 30-day mortality. Rendering SEP-1 compliant care may reduce the incidence of avoidable deaths.Copyright © 2021 American College of Chest Physicians. All rights reserved.

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