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Agency for Healthcare Research Quality

Outcomes/Effectiveness Research

More intense guideline implementation results in more patients treated appropriately for pneumonia

More intense strategies to encourage implementation of pneumonia treatment guidelines result in more appropriately treated patients with community-acquired pneumonia (CAP) seen in hospital emergency departments (EDs), concludes a new study. These strategies include ED physician receipt of the guidelines, on-site educational sessions, plus real-time reminders on how to identify patient level of risk and recommended processes of care. Researchers, supported in part by the Agency for Healthcare Research and Quality (HS10049), randomized 32 hospital EDs to low-, moderate-, and high-intensity strategies for implementing CAP guidelines.

Low-intensity EDs were advised about how to achieve CAP quality improvement (QI) and received the CAP practice guidelines and supporting literature. Moderate-intensity EDs received all of the above as well as an on-site educational session on how to use the Pneumonia Severity Index (PSI) to gauge patient risk and guide the initial site of treatment. The high-intensity EDs received all of the above plus real-time reminders and audit with feedback.

More of the 1,901 low-risk patients in the moderate-intensity (61 percent) and high-intensity (62 percent) groups were appropriately treated as outpatients than those in the low-intensity (38 percent) group. More of the 1,125 outpatients in the high-intensity group (61 percent) received all 4 recommended processes of care than those in the moderate-intensity (28.3 percent) or low-intensity (25.3 percent) group. These processes included assessment of arterial oxygenation at ED arrival, administration of the first antibiotic dose in the ED, use of appropriate antibiotic therapy, and prescribing of appropriate antibiotic therapy on ED discharge. Also, more of the 2,076 inpatients in the high-intensity group (44.3 percent) received all 4 recommended process of care than those in the moderate-intensity (30.1 percent) and low-intensity (23 percent) group.

See "Effect of increasing the intensity of implementing pneumonia guidelines," by Donald M. Yealy, M.D., Thomas E. Auble, Ph.D., Roslyn A. Stone, Ph.D., and others, in the December 20, 2005, Annals of Internal Medicine 143(12), pp. 881-894.

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