Development and evaluation of an implementation strategy for the German guideline on community-acquired pneumonia
- 1Institute for Social Medicine, Medical University of Schleswig-Holstein, Campus Luebeck, Lubeck, Germany
- 2Department of Internal Medicine/Infectious Diseases and Pulmonary Medicine, Charite, Humboldt-University-Medicine, Berlin, Germany
- 3Department of Pneumology, Hannover Medical School, Hannover, Germany
- 4Geschädtsstelle Kompetenznetz Asthma und COPD Klinik für Innere Medizin mit Schwerpunkt Pneumologie Philipps-Universtät Marburg Baldingerstrasse 1, Marburg, Germany
- Correspondence to Dr Maike Schnoor, Philipps-University, Department of Internal Medicine/Pneumology, Baldinger Str.1, 35043 Marburg, Germany;
Contributors T Welte and T Schäfer contributed equally.
- Accepted 3 January 2009
- Published Online First 13 April 2010
Background Data of the German Competence Network for Community-Acquired Pneumonia showed a gap between the recommendations of the national guideline for management of community-acquired pneumonia (CAP) and the routine care. We developed and evaluated an implementation strategy to improve the quality of care of patients with CAP.
Method A prospective, randomised, controlled trail was conducted within CAPNETZ. In four local clinical centres (LCC), the guideline was implemented by different strategies. The other four LCC served as control group. Indicators for guideline adherence comprised initial site of treatment, initial antibiotic treatment and duration of antibiotic treatment. As patient-related factors, we assessed the effect of guideline implementation on 30-day mortality and length of hospital stay.
Results Active guideline implementation yielded an increased proportion of guideline adherence to the length of antibiotic treatment in outpatients (+9.2%), the recommended antibiotic treatment (+5.6%) and duration of antibiotic treatment in inpatients (+5.0%) compared with baseline. In contrast, the proportion of patients in the control group, treated according to the guideline, decreased in the same period by 7.9%, 2.9% and 4.7%, respectively. None of these results was statistically significant. Decrease of CAP-related mortality was higher in the intervention group compared with the control group (2.9% vs 0.5%, ns).
Conclusion This study showed improvements in the process of care after implementation of a guideline for treating CAP. Further strategies, such as quality improvement cycles and medical practice audits, may enhance this effect.
- Community-acquired pneumonia
- quality of care
- randomised controlled trail
- clinical guidelines
See Commentary, p 471
Thanks to Mithat Koca, Antje Tessmer, Frank Kunitz, Torsten Bauer, Norbert Suttorp (Berlin); Santiago Ewig, Gernot Rohde (Bochum); Matthias Pletz (Hannover); Klaus Dalhoff, Meral Tosun, Petra Heyer (Lübeck); Manfred Schack, Judith Pischer, Adrian Gillisen (Leipzig); Tom Schaberg, Iris Hering (Rotenburg); Christian Schumann (Ulm), Torsten Illmann, Michael Wallner, Michael Weber (IT) Grit Barten, Ludmilla Gosmann, Michaelea Finsel (main office); and all study nurses.
Competing interests None.
Ethics approval The ethic committees of the participating universities of the competence network CAPNETZ approved the study protocol and all patients included in CAPNETZ gave informed consent to participation.
Provenance and peer review Not commissioned; externally peer reviewed.