{"id":21387,"date":"2022-05-14T04:47:00","date_gmt":"2022-05-13T20:47:00","guid":{"rendered":"http:\/\/csccm.org.cn\/?p=21387"},"modified":"2022-05-14T05:45:47","modified_gmt":"2022-05-13T21:45:47","slug":"chest%e5%8f%91%e8%a1%a8%e8%ae%ba%e6%96%87%ef%bc%9a%e6%97%a9%e6%9c%9f%e9%9b%86%e6%9d%9f%e5%8c%96%e6%b2%bb%e7%96%97sep-1%e4%be%9d%e4%bb%8e%e6%80%a7%e5%af%b9%e8%84%93%e6%af%92%e7%97%87%e6%82%a3","status":"publish","type":"post","link":"https:\/\/csccm.org.cn\/?p=21387","title":{"rendered":"[Chest\u53d1\u8868\u8bba\u6587]\uff1a\u65e9\u671f\u96c6\u675f\u5316\u6cbb\u7597(SEP-1)\u4f9d\u4ece\u6027\u5bf9\u8113\u6bd2\u75c7\u60a3\u8005\u75c5\u6b7b\u7387\u6539\u53d8\u7684\u5f71\u54cd"},"content":{"rendered":"\n

CRITICAL CARE: ORIGINAL RESEARCH| VOLUME 161, ISSUE 2<\/a>, P392-406, FEBRUARY 01, 2022<\/p>\n\n\n\n

Effects of Compliance With the Early Management Bundle (SEP-1) on Mortality Changes Among Medicare Beneficiaries With Sepsis: A Propensity Score Matched Cohort Study<\/h1>\n\n\n\n

Sean R. Townsend, Gary S. Phillips, Reena Duseja,\u00a0et al<\/h3>\n\n\n\n

Chest 2022; 161: 392-406<\/h3>\n\n\n\n

Background<\/h3>\n\n\n\n

US 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.<\/p>\n\n\n\n

Research Question<\/h3>\n\n\n\n

What is the association between compliance with SEP-1 and 30-day mortality among Medicare beneficiaries?<\/p>\n\n\n\n

Study Design And Methods<\/h3>\n\n\n\n

Studying 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.<\/p>\n\n\n\n

Results<\/h3>\n\n\n\n

We 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%\u00a0vs\u00a027.48%, respectively), yielding an absolute risk reduction (ARR) of 5.67%\u00a0(95%\u00a0CI, 5.33-6.00;\u00a0P\u00a0<<\/em>\u00a0.001). 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%\u00a0vs\u00a026.28%, respectively), yielding an ARR of 4.06%\u00a0(95%\u00a0CI, 3.70-4.41;\u00a0P\u00a0<<\/em>\u00a0.001). At the subject level, our HGLM found compliance associated with lower 30-day risk-adjusted mortality (adjusted conditional OR, 0.829; 95%\u00a0CI, 0.812-0.846;\u00a0P\u00a0<<\/em>\u00a0.001). Multiple elements correlated with lower mortality. Median length of stay was shorter among cases whose care was compliant (5 vs\u00a06\u00a0days; interquartile range, 3-9 vs\u00a04-10, respectively;\u00a0P\u00a0<<\/em>\u00a0.001).<\/p>\n\n\n\n

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Interpretation<\/h3>\n\n\n\n

Compliance with SEP-1 was associated with lower 30-day mortality. Rendering SEP-1 compliant care may reduce the incidence of avoidable deaths.<\/p>\n","protected":false},"excerpt":{"rendered":"

CRITICAL CARE: ORIGINAL RESEARCH| VOLUME 161, ISSU […]<\/p>\n","protected":false},"author":3,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":[],"categories":[32,23],"tags":[],"_links":{"self":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/21387"}],"collection":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/users\/3"}],"replies":[{"embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=21387"}],"version-history":[{"count":2,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/21387\/revisions"}],"predecessor-version":[{"id":21820,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/21387\/revisions\/21820"}],"wp:attachment":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=21387"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=21387"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=21387"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}