{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,25]],"date-time":"2026-08-25T23:58:21Z","timestamp":1787702301897,"version":"build-2784847793"},"reference-count":32,"publisher":"Oxford University Press (OUP)","issue":"3","license":[{"start":{"date-parts":[[2021,11,5]],"date-time":"2021-11-05T00:00:00Z","timestamp":1636070400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"funder":[{"DOI":"10.13039\/100000030","name":"Centers for Disease Control and Prevention","doi-asserted-by":"publisher","award":["U54CK000483"],"award-info":[{"award-number":["U54CK000483"]}],"id":[{"id":"10.13039\/100000030","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2022,8,31]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>The impact of the US Centers for Medicare &amp; Medicaid Services (CMS) Severe Sepsis and Septic Shock: Management Bundle (SEP-1) core measure on overall antibacterial utilization is unknown.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>We performed a retrospective multicenter longitudinal cohort study with interrupted time\u2013series analysis to determine the impact of SEP-1 implementation on antibacterial utilization and patient outcomes. All adult patients admitted to 26 hospitals between 1 October 2014 and 30 September 2015 (SEP-1 preparation period) and between 1 November 2015 and 31 October 2016 (SEP-1 implementation period) were evaluated for inclusion. The primary outcome was total antibacterial utilization, measured as days of therapy (DOT) per 1000 patient-days.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>The study cohort included 701 055 eligible patient admissions and 4.2 million patient-days. Overall antibacterial utilization increased 2% each month during SEP-1 preparation (relative rate [RR], 1.02 per month [95% confidence interval {CI}, 1.00\u20131.04]; P = .02). Cumulatively, the mean monthly DOT per 1000 patient-days increased 24.4% (95% CI, 18.0%\u201338.8%) over the entire study period (October 2014\u2013October 2016). The rate of sepsis diagnosis\/1000 patients increased 2% each month during SEP-1 preparation (RR, 1.02 per month [95% CI, 1.00\u20131.04]; P = .04). The rate of all-cause mortality rate per 1000 patients decreased during the study period (RR for SEP-1 preparation, 0.95 [95% CI, .92\u2013.98; P = .001]; RR for SEP-1 implementation, .98 [.97\u20131.00; P = .01]). Cumulatively, the monthly mean all-cause mortality rate\/1000 patients declined 38.5% (95% CI, 25.9%\u201348.0%) over the study period.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>Announcement and implementation of the CMS SEP-1 process measure was associated with increased diagnosis of sepsis and antibacterial utilization and decreased mortality rate among hospitalized patients.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/cid\/ciab937","type":"journal-article","created":{"date-parts":[[2021,11,1]],"date-time":"2021-11-01T20:12:41Z","timestamp":1635797561000},"page":"503-511","source":"Crossref","is-referenced-by-count":18,"title":["The Impact of Centers for Medicare &amp; Medicaid Services SEP-1 Core Measure Implementation on Antibacterial Utilization: A Retrospective Multicenter Longitudinal Cohort Study With Interrupted Time-Series Analysis"],"prefix":"10.1093","volume":"75","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6882-5496","authenticated-orcid":false,"given":"Deverick J","family":"Anderson","sequence":"first","affiliation":[{"name":"Duke Center for Antimicrobial Stewardship and Infection Prevention , Durham, North Carolina , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rebekah W","family":"Moehring","sequence":"additional","affiliation":[{"name":"Duke Center for Antimicrobial Stewardship and Infection Prevention , Durham, North Carolina , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alice","family":"Parish","sequence":"additional","affiliation":[{"name":"Department of Biostatistics and Bioinformatics, Duke University School of Medicine , Durham, North Carolina , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael Z","family":"David","sequence":"additional","affiliation":[{"name":"Department of Medicine, University of Pennsylvania , Philadelphia, Pennsylvania , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kevin","family":"Hsueh","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases, Washington University School of Medicine , St Louis, Missouri , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Leigh","family":"Cressman","sequence":"additional","affiliation":[{"name":"Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania , Philadelphia, Pennsylvania , USA and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pam","family":"Tolomeo","sequence":"additional","affiliation":[{"name":"Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania , Philadelphia, Pennsylvania , USA and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tracey","family":"Habrock-Bach","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases, Washington University School of Medicine , St Louis, Missouri , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cherie L","family":"Hill","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases, Washington University School of Medicine , St Louis, Missouri , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthew","family":"Ryan","sequence":"additional","affiliation":[{"name":"Duke Center for Antimicrobial Stewardship and Infection Prevention , Durham, North Carolina , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cara","family":"O\u2019Brien","sequence":"additional","affiliation":[{"name":"Department of Medicine, Duke University Medical Center , Durham, North Carolina , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuliya","family":"Lokhnygina","sequence":"additional","affiliation":[{"name":"Department of Biostatistics and Bioinformatics, Duke University School of Medicine , Durham, North Carolina , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elizabeth","family":"Dodds Ashley","sequence":"additional","affiliation":[{"name":"Duke Center for Antimicrobial Stewardship and Infection Prevention , Durham, North Carolina , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2021,11,5]]},"reference":[{"key":"2022083020582909700_CIT0001","doi-asserted-by":"crossref","first-page":"1546","DOI":"10.1056\/NEJMoa022139","article-title":"The epidemiology of sepsis in the United States from 1979 through 2000.","volume":"348","author":"Martin","year":"2003","journal-title":"New Engl J Med"},{"key":"2022083020582909700_CIT0002","doi-asserted-by":"crossref","first-page":"754","DOI":"10.1097\/CCM.0b013e318232db65","article-title":"Hospitalizations, costs, and outcomes of severe sepsis in the United States 2003 to 2007.","volume":"40","author":"Lagu","year":"2012","journal-title":"Crit Care 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