In response to a discussion among IDSA members via the Emerging Infections Network
(EIN), the following update is provided by Ron Nahass, MD, FIDSA, chair of the IDSA Quality Improvement Committee on the issue of the Sepsis Measure within the Centers for Medicare and Medicaid Service’s (CMS) Inpatient Quality Reporting Program
In June 2015, IDSA became aware of changes in the measure specification for the Sepsis Bundle Project performance measure (SEP-1) implemented in the National Hospital Inpatient Quality Reporting Program. Specifically, the SEP-1 measure specifications included a recommended list of broad-spectrum antibiotics for monotherapy, (see Appendix C, Table 5.0 of the Specifications Manual for National Hospital Inpatient Quality Measures, Version 5.0b
(.zip) (Note: this link opens a zip file containing several reference documents related to the Sepsis Measure). The list included several antibiotics that were deemed by IDSA to be inappropriate and excluded several antibiotics that would be appropriate for many septic cases where a source of infection is suspected or known. Based upon the specifications provided by CMS, hospitals would be penalized for appropriately treating patients with narrow-spectrum antibiotics.
In August 2015, IDSA led advocacy efforts to engage CMS, as documented in a formal joint letter
, which recommended changes to CMS on how to best correct the issues with the SEP-1 measure specifications. As a result of the comments provided by IDSA and other stakeholders, CMS instructed the Joint Commission to revise the specifications. The changes requested by IDSA and others are reflected in Specifications Manual for National Hospital Inpatient Quality Measures v.5.1
(.zip) (Note: several documents are contained within this zip file), released in December 2015, removing Augmentin, which is only available in oral formulation, and Tequin, which was removed from the market due to safety reasons.
IDSA welcomes further member input on the issues with SEP-1 measure. Please feel free to contact Andres Rodriguez, email@example.com
or Thomas Kim, firstname.lastname@example.org
, for more information regarding IDSA’s work with SEP-1.
Public Comment Period Open for Quality Measure: 72-hour Review of Sepsis Therapy
To encourage the appropriate use of broad-spectrum antibiotics, a joint work group of IDSA and the Society for Healthcare Epidemiology of America (SHEA) developed a corollary quality measure concept to track 72-hour review of all sepsis cases. This measure would require providers to review all sepsis cases at or before 72-hours of administration of broad-spectrum antibiotics for possible de-escalation according to available blood culture, diagnostic, and susceptibility data.
IDSA has opened a public comment period and welcomes public review of the 72-hour Review of Sepsis measure concept. The public comment period closes on March 22, 2016.
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