Advancing sepsis quality measurement to promote comprehensive care and improve patient outcomes

The National Heart, Lung, and Blood Institute awarded Harvard Pilgrim Health Care, Inc. $1.661 million on August 5, 2026, under the Cardiovascular Diseases Research program (CFDA 93.837) to advance sepsis quality measurement and identify system-level strategies that improve patient outcomes.

The research addresses gaps in implementing three new sepsis quality measures developed by the Centers for Disease Control and Prevention and the Centers for Medicare & Medicaid Services: the CDC Adult Community-Onset Sepsis Mortality Measure, the CDC Sepsis Program Core Elements Measure, and the CMS Sepsis 30-Day Readmissions Measure. Harvard Pilgrim will leverage detailed clinical data from millions of encounters across hundreds of hospitals within three large datasets and apply advanced statistical methods to identify the most effective process metrics, system-level interventions, and measurement strategies.

Aim 1 identifies electronic health record-based patient-level process metrics beyond the SEP-1 bundle associated with improved sepsis outcomes, evaluating candidate metrics such as antibiotic order-to-infusion time, timely second doses of antibiotics, and timely antibiotic de-escalation using rich EHR data from diverse healthcare systems. Aim 2 evaluates the impact of hospital-level sepsis diagnostic tools and structural elements on sepsis processes and outcomes. The research also includes optimizing risk adjustment methods for benchmarking sepsis readmission rates.

Performance occurs in Boston, Massachusetts. The period of performance runs through July 31, 2028. This is a Project Grant assistance type.

Abstract

Sepsis is a leading cause of death, disability, and hospital readmissions, placing a substantial burden on patients, families, and the healthcare system. National policies enacted to improve sepsis outcomes have thus far emphasized initial resuscitation bundles, but sepsis outcomes remain suboptimal, prompting policymakers to seek more effective quality improvement and measurement policies. The centers for disease control and prevention (CDC) and the centers for medicare & medicaid services (CMS) are developing three new sepsis quality measures: the CDC adult community-onset sepsis mortality measure, the CDC sepsis program core elements measure, and the CMS sepsis 30-day readmissions measure. While these measures represent an important step forward, there is little data to guide hospitals on how best to succeed on these measures. Gaps include identifying the most effective process metrics, system-level interventions, and measurement strategies to improve sepsis outcomes. This study addresses these gaps by leveraging detailed clinical data from millions of encounters across hundreds of hospitals within three large, complementary datasets and applying advanced statistical methods to identify systems-level strategies associated with better outcomes, including optimizing risk adjustment methods for benchmarking sepsis readmission rates. Aim 1 will identify electronic health record (EHR)-based patient-level process metrics beyond the SEP-1 bundle that are associated with improved sepsis outcomes. We will evaluate candidate metrics, such as antibiotic order-to-infusion time, timely second doses of antibiotics, and timely antibiotic DE-escalation, using rich EHR data from diverse healthcare systems. Aim 2 will evaluate the impact of hospital-level sepsis diagnostic tools and structural elements on sepsis processes and outcomes. We will compare outcomes between hospitals that use rapid molecular diagnostics and those that do not, and we will assess associations between hospitals' adherence to the CDC sepsis program core elements and risk-adjusted mortality rates. Aim 3 will develop a risk-adjusted EHR-based 30-day readmission measure using detailed EHR data from sepsis admissions among medicare beneficiaries and compare its performance with CMS's claims-based model with respect to predictive accuracy and ranking of hospitals. Our overarching hypothesis is that improving sepsis outcomes requires a comprehensive approach that integrates patient-level process metrics, hospital-level interventions, and accurate EHR-based measurement strategies. This study will be led by a highly experienced, multidisciplinary team that includes internationally recognized leaders in sepsis surveillance, diagnosis, management, and quality measurement. By identifying actionable care processes, evaluating hospital-level interventions and structural elements, and comparing competing measurement strategies, this project will generate robust evidence to inform next-generation sepsis quality metrics and advance national efforts to improve sepsis care, patient outcomes, and healthcare accountability.