Aaronson Emily L, Filbin Michael R, Brown David F M, Tobin Kathy, Mort Elizabeth A
Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts; Lawrence Center for Quality and Safety, Massachusetts General Hospital and Massachusetts General Physicians' Organization, Boston, Massachusetts.
Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.
J Emerg Med. 2017 Jan;52(1):109-116. doi: 10.1016/j.jemermed.2016.08.009. Epub 2016 Oct 5.
The release of the Center for Medicare and Medicaid Service's (CMS) latest quality measure, Severe Sepsis/Septic Shock Early Management Bundle (SEP-1), has intensified the long-standing debate over optimal care for severe sepsis and septic shock. Although the last decade of research has demonstrated the importance of comprehensive bundled care in conjunction with compliance mechanisms to reduce patient mortality, it is not clear that SEP-1 achieves this aim. The heterogeneous and often cryptic presentation of severe sepsis and septic shock, along with the multifaceted criteria for the definition of this clinical syndrome, pose a particular challenge for fitting requirements to this disease, and implementation could have unintended consequences.
Following a simulated reporting exercise, in which 50 charts underwent expert review, we aimed to detail the challenges of, and offer suggestions on how to rethink, measuring performance in severe sepsis and septic shock care.
There were several challenges associated with the design and implementation of this measure. The ambiguous definition of severe sepsis and septic shock, prescriptive fluid volume requirements, rigid reassessment, and complex abstraction logic all raise significant concern.
Although SEP-1 represents an important first step in requiring hospitals to improve outcomes for patients with severe sepsis and septic shock, the current approach must be revisited. The volume and complexity of the currently required SEP-1 reporting elements deserve serious consideration and revision before they are used as measures of accountability and tied to reimbursement.
医疗保险和医疗补助服务中心（CMS）发布了最新的质量指标——严重脓毒症/脓毒性休克早期管理集束方案（SEP-1），这加剧了长期以来关于严重脓毒症和脓毒性休克最佳治疗的争论。尽管过去十年的研究表明，综合集束治疗结合合规机制对于降低患者死亡率很重要，但尚不清楚SEP-1是否能实现这一目标。严重脓毒症和脓毒性休克的表现多样且常常隐匿，再加上该临床综合征定义的多方面标准，给将要求适配于这种疾病带来了特殊挑战，而且实施可能会产生意想不到的后果。
在一项模拟报告演练中，对50份病历进行了专家评审，我们旨在详细阐述在严重脓毒症和脓毒性休克护理中衡量绩效所面临的挑战，并就如何重新思考这一问题提供建议。
这项指标的设计和实施存在若干挑战。严重脓毒症和脓毒性休克的定义不明确、规定的液体量要求、严格的重新评估以及复杂的提取逻辑都引发了重大担忧。
尽管SEP-1是要求医院改善严重脓毒症和脓毒性休克患者治疗效果的重要第一步，但当前方法必须重新审视。在将当前要求的SEP-1报告要素用作问责措施并与报销挂钩之前，其数量和复杂性值得认真考虑和修订。
