Inter-rater Agreement for Abstraction of the Early Management Bundle, Severe Sepsis/Septic Shock (SEP-1) Quality Measure in a Multi-Hospital Health System.

BACKGROUND: The Early Management Bundle, Severe Sepsis/Septic Shock (SEP-1) quality measure is complex to abstract, which may lead to discrepancies between abstractors. This study was designed to evaluate inter-rater agreement between abstractors at individual hospitals in a health system and a lead abstractor on abstraction elements and measure compliance for SEP-1.

METHODS: Patient cases qualifying for abstraction for SEP-1 over a four-month period in 2016 were initially abstracted at a local hospital and then centrally by a lead abstractor. Abstraction results were retrospectively compared to determine inter-rater agreement.

RESULTS: A total of 580 SEP-1 cases were abstracted locally and centrally. Each site contributed a median (interquartile range) of 63 (49, 86) cases. There was complete concordance of measure-related elements in 391 cases (67%) (inter-rater agreement: κ = 0.40, p < 0.01). The most common discrepancy (60 cases) was severe sepsis presentation time. There was a weak correlation between SEP-1 compliance adjudicated locally and centrally (r2  = 0.41, p < 0.01). The average change in monthly SEP-1 measure compliance at each site after central adjudication was a 1% increase but ranged from a 49% decrease to a 40% increase.

CONCLUSIONS: Concordance on SEP-1 abstraction elements between local and expert adjudicators was fair, and SEP-1 performance varied considerably from initial site-reported performance. The detailed nature of SEP-1 can lead to unreliable abstraction, which may lead to inaccurate reporting of compliance with the measure and affect comparability of performance between hospitals. Abstraction by a dedicated team for SEP-1 can reduce variability and improve efficiency.