News: National Quality Forum rejects appeal on sepsis measure

The National Quality Forum (NQF) rejected an appeal of its decision to endorse the Severe Sepsis and Septic Shock: Management Bundle (or SEP-1) measure for treating sepsis. The NQF originally endorsed the measure in 2013, and it was first implemented by CMS in October 2015. According to MedPage Today, one of the unusual features of the measure is that, instead of being stewarded by the American Medical Association, CMS, or an infectious disease association, it’s stewarded by the Henry Ford Hospital in Detroit.

Over the years, the measure has been the center of much controversy. Some physicians felt that the measure brought attention to sepsis and helped save lives. Others, however, felt that the measure’s requirements and timelines “encourage excessive fluids and antibiotics, curtail clinicians’ latitude to calibrate their management to their certainty of infection and patients’ severity of illness, and unduly anchor providers’ diagnostic focus on sepsis to the exclusion of other serious conditions,” according to a 2021 editorial in the Annals of Internal Medicine.

Despite the controversy, the NQF re-endorsed the measure for a third time in 2021. Several infectious disease and emergency medicine groups filed an appeal with NQF in January 2022. In their appeal, the groups expressed concern over how the measure was re-endorsed. Specifically, three members were excluded from the decision due to “conflicts of interest” that amounted to their expertise and publishing history on the topic of sepsis. Several other members who were directly involved with the measure’s steward were allowed to participate in the re-endorsement process.

Additionally, the groups also felt that the re-endorsement ignored several pieces of research that show the ineffectiveness of the SEP-1 measure.

During the April 29, 2022, hearing, the five participating members of the NQF’s appeals board voted unanimously against the appeal.

Editor’s note: To read MedPage Today’s coverage of this story, click here. To read more about the SEP-1 measure, click here.