Limited impact of a multicenter intervention to improve the quality and efficiency of pneumonia care - PubMed (original) (raw)
Multicenter Study
Limited impact of a multicenter intervention to improve the quality and efficiency of pneumonia care
Ethan A Halm et al. Chest. 2004 Jul.
Abstract
Study objectives: To evaluate the impact of a multifactorial intervention to improve the quality, efficiency, and patient understanding of care for community-acquired pneumonia.
Design: Times series cohort study.
Setting: Four academic health centers in the New York City metropolitan area.
Patients or participants: All consecutive adults hospitalized for pneumonia during a 5-month period before (n = 1,013) and after (n = 1,081) implementation of an inpatient quality improvement (QI) initiative.
Interventions: A multidisciplinary team of opinion leaders developed evidence-based treatment guidelines and critical pathways, conducted educational sessions with physicians, distributed pocket reminder cards, promoted standardized orders, and developed bilingual patient education materials.
Measurements and results: The average age was 71.4 years, and 44.1% of cases were low risk, 36.8% were moderate risk, and 19.2% were high risk. The preintervention and postintervention groups were well matched on age, sex, race, nursing home residence, pneumonia severity, initial presentation, and most major comorbidities. The intervention increased the use of guideline-recommended antimicrobial therapy from 78.1 to 83.4% (p = 0.003). There was also a borderline decrease in the proportion of patients being discharged prior to becoming clinically stable, from 27.0 to 23.5% (p = 0.06). However, there were no improvements in the other targeted indicators, including time to first dose of antibiotics, proportion receiving antibiotics within 8 h, timely switch to oral antibiotics, timely discharge, length of stay, or patient education outcomes.
Conclusions: This real-world QI program was able to improve modestly on some quality indicators, but not effect resource use or patient knowledge of their disease. Changing physician and organizational behavior in academic health centers will require the development and implementation of more intensive, system-oriented strategies.
Figures
Figure 1
Effect of intervention on first-line antibiotic therapy over time. The arrow divides the preintervention from the postintervention periods. There was also a significant reduction in the monthly variation on this measure (preintervention vs postintervention, p < 0.003)
Similar articles
- Comparison of processes and outcomes of pneumonia care between hospitalists and community-based primary care physicians.
Rifkin WD, Conner D, Silver A, Eichorn A. Rifkin WD, et al. Mayo Clin Proc. 2002 Oct;77(10):1053-8. doi: 10.4065/77.10.1053. Mayo Clin Proc. 2002. PMID: 12374249 - Antibiotic use, hospital admissions, and mortality before and after implementing guidelines for nursing home-acquired pneumonia.
Naughton BJ, Mylotte JM, Ramadan F, Karuza J, Priore RL. Naughton BJ, et al. J Am Geriatr Soc. 2001 Aug;49(8):1020-4. doi: 10.1046/j.1532-5415.2001.49203.x. J Am Geriatr Soc. 2001. PMID: 11555061 Clinical Trial. - Impact of postgraduate education on physician practice for community-acquired pneumonia.
Ikai H, Morimoto T, Shimbo T, Imanaka Y, Koike K. Ikai H, et al. J Eval Clin Pract. 2012 Apr;18(2):389-95. doi: 10.1111/j.1365-2753.2010.01594.x. Epub 2011 Jan 5. J Eval Clin Pract. 2012. PMID: 21208347 - Evidence-based emergency medicine/critically appraised topic. Evidence behind the 4-hour rule for initiation of antibiotic therapy in community-acquired pneumonia.
Yu KT, Wyer PC. Yu KT, et al. Ann Emerg Med. 2008 May;51(5):651-62, 662.e1-2. doi: 10.1016/j.annemergmed.2007.10.022. Epub 2008 Feb 13. Ann Emerg Med. 2008. PMID: 18272253 Review. - Community-acquired pneumonia in adults: initial antibiotic therapy.
King DE, Pippin HJ Jr. King DE, et al. Am Fam Physician. 1997 Aug;56(2):544-50. Am Fam Physician. 1997. PMID: 9262534 Review.
Cited by
- Interventions to improve antibiotic prescribing practices for hospital inpatients.
Davey P, Marwick CA, Scott CL, Charani E, McNeil K, Brown E, Gould IM, Ramsay CR, Michie S. Davey P, et al. Cochrane Database Syst Rev. 2017 Feb 9;2(2):CD003543. doi: 10.1002/14651858.CD003543.pub4. Cochrane Database Syst Rev. 2017. PMID: 28178770 Free PMC article. Review. - Impact of an Educational Program to Reduce Healthcare Resources in Community-Acquired Pneumonia: The EDUCAP Randomized Controlled Trial.
Adamuz J, Viasus D, Simonetti A, Jiménez-Martínez E, Molero L, González-Samartino M, Castillo E, Juvé-Udina ME, Alcocer MJ, Hernández C, Buera MP, Roel A, Abad E, Zabalegui A, Ricart P, Gonzalez A, Isla P, Dorca J, Garcia-Vidal C, Carratalà J. Adamuz J, et al. PLoS One. 2015 Oct 13;10(10):e0140202. doi: 10.1371/journal.pone.0140202. eCollection 2015. PLoS One. 2015. PMID: 26460907 Free PMC article. Clinical Trial. - Educational interventions to improve prescription and dispensing of antibiotics: a systematic review.
Roque F, Herdeiro MT, Soares S, Teixeira Rodrigues A, Breitenfeld L, Figueiras A. Roque F, et al. BMC Public Health. 2014 Dec 15;14:1276. doi: 10.1186/1471-2458-14-1276. BMC Public Health. 2014. PMID: 25511932 Free PMC article. Review. - A 10 year (2000-2010) systematic review of interventions to improve quality of care in hospitals.
Conry MC, Humphries N, Morgan K, McGowan Y, Montgomery A, Vedhara K, Panagopoulou E, Mc Gee H. Conry MC, et al. BMC Health Serv Res. 2012 Aug 24;12:275. doi: 10.1186/1472-6963-12-275. BMC Health Serv Res. 2012. PMID: 22925835 Free PMC article. Review. - Hospital admission decision for patients with community-acquired pneumonia: variability among physicians in an emergency department.
Dean NC, Jones JP, Aronsky D, Brown S, Vines CG, Jones BE, Allen T. Dean NC, et al. Ann Emerg Med. 2012 Jan;59(1):35-41. doi: 10.1016/j.annemergmed.2011.07.032. Epub 2011 Sep 9. Ann Emerg Med. 2012. PMID: 21907451 Free PMC article.
References
- Clinical classifications for health policy research: hospital inpatient statistics, 1996. Rockville, MD: Agency for Health Care Policy and Research; 1999. publication No. 99–0034.
- Niederman MS, McCombs JS, Unger AN, et al. The cost of treating community-acquired pneumonia. Clin Ther. 1998;20:820–837. - PubMed
- Pneumonia and influenza death rates–United States, 1979–1994. MMWR Morb Mortal Wkly Rep. 1995;44:535–537. - PubMed
- Fine MJ, Orloff JJ, Arisumi D, et al. Prognosis of patients hospitalized with community-acquired pneumonia. Am J Med. 1990;88:1N–8N. - PubMed
- Meehan TP, Fine MJ, Krumholz HM, et al. Quality of care, process, and outcomes in elderly patients with pneumonia. JAMA. 1997;278:2080–2084. - PubMed
Publication types
MeSH terms
Substances
LinkOut - more resources
Full Text Sources
Medical