First Day with GPT4 Online: Considers SEP1 Controvery

 I asked the GPT4 AI (the subscription level) some questions about SEP1 and even a mock up model comment letter.  I am not saying this is useful, but it is interesting nonethless to see what it comes up with.  The newest version just began to give two modes.  In the classic mode, it searches its own knowledge to 2021 and writes.  In the alternate "browser" mode, it silently spends a minute collecting google hits and then writes a memo based on them.

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Can you research and report on recent controversy about the CMS or Medicare quality measure called sep-1?  This could straddle 2019-2023.  That is, you may benefit from your native resources up to 2021, and you may also benefit from de novo Internet research. I am an expert and can appreciate a detailed analysis .

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Finished browsing

The Severe Sepsis/Septic Shock Management Bundle, also known as SEP-1, is a performance measure introduced by the Centers for Medicare and Medicaid Services (CMS) in October 2015 to standardize the care of sepsis patients across healthcare organizations. Public reporting of hospital performance on SEP-1 began in 2018. The measure does not currently include any financial incentives or disincentives based on performance, and there is a wide variation in SEP-1 performance across hospitals​1​.

SEP-1 is a complex, composite, "all or none" quality measure that requires a high degree of manual medical record abstraction. Some components of SEP-1, such as fluid bolus, have sparked debate, while others, like reducing the time to sepsis recognition and the time to appropriate antibiotics, are widely accepted. It's been suggested that the measure's complexity and the resources required for data abstraction and reporting to CMS may divert attention from other potential clinical focuses, even for high-priority conditions such as sepsis​2​.

The effectiveness of SEP-1 has been controversial. A study by Rhee et al made use of electronic health data to evaluate the association between SEP-1 implementation and outcomes for sepsis patients across 114 hospitals. This study found no association between short-term mortality and SEP-1 measurement implementation. However, it's not entirely clear whether these hospitals are representative of all hospitals in the US engaging in SEP-1 implementation. Another recent study by Townsend et al reported that compliance with SEP-1 is associated with a lower 30-day mortality. This indicates that SEP-1-compliant care may, in fact, reduce preventable deaths​3​.

Despite these conflicting findings, it's crucial to consider that the association between a quality metric such as SEP-1, which represents processes of care, and an outcome such as mortality, raises more questions than it answers. Multiple potential explanations could account for this, including the underlying science behind the interventions, the technical construction of the measure, the measure's implementation, the chosen outcomes of interest, and the population and methodology used to evaluate the measure. It's also essential to acknowledge that not all hospitals benefit equally from quality initiatives, presenting challenges for widespread improvement efforts​4​.

Some suggest that one way forward for SEP-1 may be to deconstruct the metric and/or revisit its "all or none" nature. This might involve learning from successful healthcare organizations with a high-quality care and outcomes track record. For example, sepsis initiatives in New York State have proven effective through a combination of broad stakeholder engagement and required elements of structure (sepsis protocols), process, and outcome measures (bundled care and risk-adjusted mortality)​5​.

Unfortunately, due to time constraints, I was not able to find more recent information on the controversy surrounding the SEP-1 quality measure beyond early 2023. For a more comprehensive understanding of the current situation, further investigation would be needed.