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Star Research Presentations: Epidemiology/Outcomes

Development and Testing of a National Electronic Mortality Measure for Adult Community-Onset Sepsis

Monday, March 23, 2026
10:10 AM - 11:10 AM Central Time
Location: Connections Central Theater 2

  • Chanu Rhee, MD, MPH, FCCM (he/him/his)

    Harvard Medical School, Massachusetts

    Disclosure(s): No relevant financial relationship(s) to disclose.

  • TY

    Tingting Yu, PhD

    Instructor
    Harvard Pilgrim Health Care Institute

    Disclosure information not submitted.

  • RD

    Raymund Dantes, MD

    Associate Professor
    Emory University Hospital

    Disclosure information not submitted.

  • QL

    Qunna Li, MSPH

    Health Scientist
    Centers for Disease Control and Prevention

    Disclosure information not submitted.

  • KB

    Kristina Betz, MD

    Public Health Physician
    Centers for Disease Control and Prevention

    Disclosure information not submitted.

  • JE

    Jonathan Edwards, MSc

    Research Mathematical Statistician
    Centers for Disease Control and Prevention

    Disclosure information not submitted.

  • MS

    Minn Soe, N/A

    General Health SCientist
    Centers for Disease Control and Prevention

    Disclosure information not submitted.

  • SD

    Scott Decker, N/A

    Project Manager
    Centers for Disease Control and Prevention

    Disclosure information not submitted.

  • CC

    Christina Chan, MPH

    Senior Research Analyst
    Harvard Pilgrim Health Care Institute

    Disclosure information not submitted.

  • RJ

    Robert Jin, N/A

    Senior Research Analyst
    Harvard Pilgrim Health Care Institute

    Disclosure information not submitted.

  • SA

    Stefanie Albert, N/A

    Research Analyst
    Harvard Pilgrim Health Care Institute

    Disclosure information not submitted.

  • LD

    Laura DelloStritto, MPH

    Project Manager
    Harvard Pilgrim Health Care Institue

    Disclosure information not submitted.

  • JG

    Jeffrey Guy, MD

    Corporate Vice President
    HCA Healthcare

    Disclosure information not submitted.

  • KS

    Kenneth Sands, MD

    Chief Epidemiologist
    HCA Healthcare

    Disclosure information not submitted.

  • RP

    Russell Poland, PhD

    AVP for Health Sciences & Population Health Research
    HCA Healthcare

    Disclosure information not submitted.

  • Sameer Kadri, MD, MS

    National Institutes of Health Clinical Center

    Disclosure information not submitted.

  • HC

    Huai-Chun Chen, PhD

    Principal Analyst
    Commonwealth Informatics

    Disclosure information not submitted.

  • VM

    Vinitha Meyyur, PhD

    Division Deputy Director of Quality Measurement
    Centers for Medicare and Medicaid Services

    Disclosure information not submitted.

  • RK

    Ron Kline, MD

    Chief Medical Officer, Quality Measurement and Value-based Incentives Group
    Centers for Medicare and Medicaid Services

    Disclosure information not submitted.

  • AB

    Andrea Benin, MD

    Chief, Surveillance Branch, Division of Healthcare Quality Promotion
    Centers for Disease Control and Prevention

    Disclosure information not submitted.

Introduction: Benchmarking sepsis outcomes is essential to improving care. CDC and CMS are developing an electronic mortality outcome measure for adult community-onset (CO) sepsis based on CDC’s Adult Sepsis Event (ASE) definition (updated to enhance performance) and applied using electronic health record (EHR) and administrative claims data. We developed a risk-adjustment model for CO-sepsis mortality and assessed its discrimination, calibration, reliability, and validity using 3 large multi-hospital datasets.


Methods: We identified CO-sepsis cases by applying ASE criteria to EHR data from 268 hospitals during 2022-2023: HCA Healthcare (n=126 hospitals, MediTech), Mass General Brigham (n=9, Epic), and PINC AI (n=133, various EHRs). We developed a logistic regression model to predict mortality (hospital death or hospice discharge) using administrative and clinical data available within 6-24h of arrival. We assessed discrimination (AUROC), calibration (Brier score), and validated the model using bootstrap methods. We evaluated hospital-level reliability (signal-to-noise ratio) and validity by correlating hospital standardized mortality ratios (SMRs) with CMS quality metrics (SEP-1, 30-day pneumonia mortality, and hospital quality star ratings), as well as expert/patient panel feedback.


Results: Of 434,233 CO-sepsis hospitalizations at 268 hospitals, 85,978 (19.8%) ended in death or hospice. The model showed excellent discrimination (AUROC 0.832) and good calibration (Brier score 0.12). Median SMR was 0.99 (10th–90th percentile: 0.78-1.29) and median signal-to-noise ratio was 0.92. SMRs did not significantly correlate with SEP-1 scores (Spearman’s ρ=0.04, p=0.62) but correlated with pneumonia mortality (ρ=0.27, p< 0.01) and quality star ratings (ρ=-0.29, p< 0.01). Expert and patient panels unanimously endorsed the measure’s face validity in distinguishing hospital performance.


Conclusions: CDC’s proposed Adult CO-Sepsis Mortality Measure, based on updated ASE criteria and detailed risk adjustment, demonstrated strong performance across diverse hospital datasets and construct validity through correlation with expected outcome and global quality measures. Its lack of correlation with SEP-1 underscores the need for broader strategies to improve sepsis care and the added value of an EHR-based outcome measure.