Brief observationEffects of a practice guideline for community-acquired pneumonia in an outpatient setting☆
Section snippets
Methods
A multidisciplinary team developed the practice guideline, which directed specific antibiotic choices and hospital admission based on severity assessment (11). Our guideline followed 1993 American Thoracic Society recommendations. The study sample included consecutive immunocompetent pneumonia patients ≥18 years old, treated at four Instacares, which are high-volume, urgent care clinics that are staffed to provide acute walk-in care 14 hours daily (no ambulance or long-term care facility
Results
Four hundred sixty-three patients were identified: 199 before guideline implementation (control period) and 264 after guideline implementation (intervention period). The practice guideline form was completed for 238 of 264 (90%) patients. Age, sex, smoking history, pneumonia severity index, pneumonia severity index risk class, and number of risk factors did not differ between the groups (Table 1).
The rate of hospital admission was twice as great during the control period (14% versus 6%, P =
Discussion
After implementation of a pneumonia guideline, the hospital admission rate for patients with community-acquired pneumonia seen at three urgent care clinics decreased without a detectable difference in baseline severity of illness. While the focus of the guideline was quality of care, it also resulted in substantial cost savings. Saving $45 per patient for antibiotic therapy amounts to $135 million if extrapolated to the estimated 3 million outpatients with pneumonia treated annually in the
References (13)
Hospitalization decision in patients with community-acquired pneumoniaa prospective cohort study
Am J Med
(1990)- et al.
The cost of treating community-acquired pneumonia
Clin Ther
(1998) - et al.
Safely increasing the proportion of patients with community-acquired pneumonia treated as outpatients
Arch Intern Med
(1998) - et al.
Medical outcomes and antimicrobial costs with the use of the American Thoracic Society guidelines for outpatients with community-acquired pneumonia
JAMA
(1997) - et al.
The hospital discharge decision for patients with community-acquired pneumonia
Arch Intern Med
(1997) - et al.
The hospital admission decision for patients with community-acquired pneumonia
Arch Intern Med
(1997)
Cited by (54)
Guidelines and Quality Measures. Do They Improve Outcomes of Patients with Community-Acquired Pneumonia?
2013, Infectious Disease Clinics of North AmericaCitation Excerpt :Threefold lower costs were found in those 60 years or younger without comorbidity given therapy consistent with the guidelines, but no significant differences in medical outcomes were found. A later study found that by following the ATS recommendations of 1993, hospital admission rates for CAP patients seen at urgent care clinics decreased.6,7 Table 1 lists references of relevant studies examining the effects of guidelines on various outcome measures.
The impact of guidelines on the outcomes of community-acquired and ventilator-associated pneumonia
2011, Clinics in Chest MedicineCitation Excerpt :Gleason and colleagues19 showed a good adherence to the ATS guidelines,20 with differences in costs but not in outcomes. Suchyta and colleagues21 found a decrease in admissions when there was higher adherence to a pneumonia guideline without reporting adverse effects. Concerning hospitalized patients with CAP, there is more information about the impact of compliance with antibiotic treatment on outcomes (Tables 1 and 2).
C reactive protein, procalcitonin and proadrenomedullin in the outcome of hospitalized pneumonia patients
2011, Revista del Laboratorio ClinicoSevere Community-Acquired Pneumonia
2009, Infectious Disease Clinics of North America
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Supported in part by an unrestricted educational grant from PfizerUSPG.