Chest
Original Research: PneumoniaImproved Clinical Outcomes With Utilization of a Community-Acquired Pneumonia Guideline
Section snippets
MATERIALS AND METHODS
A pneumonia guideline was introduced in Intermountain Healthcare hospitals and outpatient facilities between January 1995 and January 1998. We have reviewed the methods of guideline development and implementation.11 Briefly, clinicians developed the guideline in conjunction with administrative and data support personnel by combining local practices with American Thoracic Society and Infectious Disease Society of America recommendations for treating community-acquired pneumonia. Guideline
RESULTS
The Utah Medicare fee-for-service population ≥ 65 years of age averaged 185,310 beneficiaries during the study years, ranging from 133,130 in 1994 to 223,846 in 2003. Altogether, the 10 years comprise 1,853,097 patient-years and 32,888 pneumonia hospital admissions. The hospital admission rate was therefore 17.7 per 1,000 patient years, ranging from 17.0 in 1998 to 22.4 in 1995. After the exclusions enumerated in Table 2, 17,728 pneumonia admissions remained for analysis. Mean (± SD) age of the
DISCUSSION
The Intermountain Healthcare pneumonia guideline was associated with decreased all-cause 30-day mortality in this 10-year analysis. Lower mortality was linked with administration of specific guideline-recommended antibiotics, a marker for use of other guideline elements in our view. Intermountain Healthcare hospitals demonstrate lower mortality compared with other Utah hospitals. These results confirm our earlier study28 while using better adjustment for comorbidities, a longer period of study,
CONCLUSION
We have validated the Intermountain Healthcare pneumonia guideline and in turn the specialty society recommendations from which it was derived. This study only included patients ≥ 66 years old, but the principles of care likely apply equally to younger pneumonia patients, saving additional lives. Implementing a guideline that standardizes treatment for most patients according to literature-based, current recommendations appears beneficial.
ACKNOWLEDGEMENT
We thank the nurses, respiratory therapists, pharmacists, administrators, and physicians of Intermountain Healthcare for collaborating to improve pneumonia care.
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The authors have no relevant conflicts of interest to report.
This study was funded by the Deseret Foundation and HealthInsight, Salt Lake City.
The analyses upon which this publication is based were performed under contract No. 500–02–UT01, funded by the Centers for Medicare and Medicaid Services, an agency of the US Department of Health and Human Services. The content of this publication does not necessarily reflect the views or policies of the Department of Health and Human Services, nor does mention of trade names, commercial products, or organizationsimply endorsement by the US government. The authors assume full responsibility for the accuracy and completeness of the ideas presented.
Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (www.chestjournal.org/misc/reprints.shtml).