A statewide initiative to improve the care of hospitalized pneumonia patients: the Connecticut Pneumonia Pathway Project

Meehan, Thomas P.; Weingarten, Scott; Holmboe, Eric S.; Mathur, Deepak; Wang, Yun; Petrillo, Marcia K.; Tu, George; Fine, Jonathan

doi:10.1016/s0002-9343(01)00803-8

Cited by 87 publications

(60 citation statements)

References 17 publications

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“…A statewide pneumonia QI initiative found overall decreases in time to initial dose of antibiotics and length of stay; however, there was significant variation among sites with some hospitals having improved their performance, some remaining unchanged, and others worsening. 37 Implementation of a health system-wide pneumonia guideline was associated with lower mortality rates compared to non-guideline hospitals in Utah. 38 Use of a pneumonia guideline in an health maintenance organization urgent-care setting increased use of recommended antibiotics and reduced length of stay.…”

Section: Discussionmentioning

confidence: 99%

Limited Impact of a Multicenter Intervention To Improve the Quality and Efficiency of Pneumonia Care

Halm

Horowitz

Silver

et al. 2004

Chest

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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.Correspondence to: Ethan A. Halm, MD, MPH, Division of General Internal Medicine, Box 1087, Mount Sinai School of Medicine, One Gustave L. Levy Place, New York, NY 10029; ethan.halm@mountsinai.org. Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (permissions@chestnet.org). NIH Public Access Author ManuscriptChest. Author manuscript; available in PMC 2015 January 21. Published in final edited form as:Chest. 2004 July ; 126(1): 100-107. doi:10.1378/chest.126.1.100. NIH-PA Author ManuscriptNIH-PA Author Manuscript NIH-PA Author ManuscriptConclusions-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.Keywords antibiotic therapy; guidelines; outcomes; pneumonia; quality improvementNearly one million patients are hospitalized with community-acquired pneumonia each year in the United States, at an annual cost of $9 billion. 1,2 It is the most common infectious cause of death, the sixth-leading cause of death overall, and has an average mortality rate of 14%. 3,4 Previous work 5-8 has demonstrated substantial variations in the quality of inpatient pneumonia care between hospitals ...

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Section: Discussionmentioning

confidence: 99%

Limited Impact of a Multicenter Intervention To Improve the Quality and Efficiency of Pneumonia Care

Halm

Horowitz

Silver

et al. 2004

Chest

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“…8,35 Pathway use was associated with increased use of angiotensin-converting enzyme inhibitors in HF patients, 36 and improved oxygen assessment and timely antibiotic administration in pneumonia patients. 37 Among patients who underwent hip or knee arthroplasty, pathways were known to decrease the use of inappropriate perioperative antibiotics 38 and to lower readmission rate. 39 A greater percentage of top performing hospitals also had a multidisciplinary team with the goal of improving care for AMI and HF.…”

Section: Discussionmentioning

confidence: 99%

Relationship Between Organizational Factors and Performance Among Pay-for-Performance Hospitals

et al. 2009

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Services (CMS)/Premier Hospital Quality Incentive Demonstration (HQID) project aims to improve clinical performance through a pay-for-performance program. We conducted this study to identify the key organizational factors associated with higher performance.METHODS: An investigator-blinded, structured telephone survey of eligible hospitals' (N=92) quality improvement (QI) leaders was conducted among HQID hospitals in the top 2 or bottom 2 deciles submitting performance measure data from October 2004 to September 2005. The survey covered topics such as QI interventions, data feedback, physician leadership, support for QI efforts, and organizational culture. RESULTS:More top performing hospitals used clinical pathways for the treatment of AMI (49% vs. 15%, p< 0.01), HF (44% vs. 18%, p<0.01), PN (38% vs. 13%, p< 0.01) and THR/TKR (56% vs. 23%, p<0.01); organized into multidisciplinary teams to manage patients with AMI (93% vs. 77%, p<0.05) and HF (93% vs. 69%, p< 0.01); used order sets for the treatment of THR/TKR (91% vs. 64%, p<0.01); and implemented computerized physician order entry in the hospital (24.4% vs. 7.9%, p<0.05). Finally, more top performers reported having adequate human resources for QI projects (p<0.01); support of the nursing staff to increase adherence to quality indicators (p < 0.01); and an organizational culture that supported coordination of care (p<0.01), pace of change (p<0.01), willingness to try new projects (p <0.01), and a focus on identifying system errors rather than blaming individuals (p<0.05).CONCLUSIONS: Organizational structure, support, and culture are associated with high performance among hospitals participating in a pay-for-performance demonstration project. Multiple organizational factors remain important in optimizing clinical care.KEY WORDS: organizational factors; organizational culture; hospital performance measurement.

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“…The variability in the duration of hospitalisation with respect to hospital type emphasises the need for objective criteria for the treatment of CAP, so as to reduce the differences in the clinical management of this condition [13,17,34,35]. These aspects are beginning to be incorporated in the latest guidelines of the American Thoracic Society [23].…”

Section: Discussionmentioning

confidence: 99%

Duration of length of stay in pneumonia: influence of clinical factors and hospital type

Menéndez¹,

Cremades²,

Martínez‐Moragón³

et al. 2003

Eur Respir J

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Length of stay (LOS) in hospital for community-acquired pneumonia depends on the characteristics of the patient and hospital. The present study sought to identify these variables within the first 24 h of hospitalisation.Patients hospitalised for pneumonia in four hospitals (one teaching and three general hospitals) had their data analysed by univariate and multivariate statististics. The variables entered were LOS, demographical characteristics, referral source, comorbidity, initial severity of illness, laboratory analyses, initial radiograph findings and antibiotic treatment regimens.The study sample included 425 patients. The overall mortality was 8.2% and the median LOS was 9 days. Using LOS as a dependent variable, three multivariate linear regression analyses were performed with: 1) the whole cohort; 2) the low-risk classes (categories I and II of Fine); and 3) the high-risk classes (categories III, IV and V of Fine). The mathematical model identified hypoxemia, low diastolic pressure, pleural effusion, multi-lobe involvement and hypoalbuminaemia as associated with longer stays in risk classes III-V, while in the low-risk patients (I-II) only hypoxemia and pleural effusion appeared in the equation. Following adjustment for these clinical variables, the LOS remained lower in some hospitals.Several independent clinical factors increased the pneumonia-associated length of stay with significant differences between hospitals. Hypoxemia and pleural effusions were the predictive variables of length of stay in low-risk patients and, additionally, diastolic blood pressure, multi-lobe involvement and hypoalbuminaemia were significant in the higher-risk classes III-V. Eur Respir J 2003; 22: 643-648. Community-acquired pneumonia (CAP) is the cause of hospitalisation for 3-5 per 1000 adults per year and with a mortality rate of 5-15%. Pneumonia is the infectious disease with the highest health costs [1][2][3][4] and, since approximately one-third of all patients with CAP are treated in hospital, the resulting costs constitute a significant part of the overall direct costs of infectious diseases [5][6][7]. The most important component of these costs is the length of stay (LOS) in hospital and estimates indicate these costs to be higher than those of the diagnostic tests involved and the subsequent antimicrobial treatments administered [6].There is considerable variability in LOS between hospitals. Reported findings are discordant and depend on the types of hospital in which the different studies had been conducted [8][9][10][11]. The differences might reflect variations in clinical practice preferences, hospital characteristics and patient characteristics and attitudes. Over recent years the LOS appears to have decreased from 9 to 6 days [12, 13] as a result of several strategies and practical guidelines that have been proposed in order to safely reduce the number of hospitalisation days [14].The LOS is influenced by several clinical factors, such as the Pneumonia Severity Index (PSI) [15] associated comorbidit...

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A statewide initiative to improve the care of hospitalized pneumonia patients: the Connecticut Pneumonia Pathway Project

Cited by 87 publications

References 17 publications

Limited Impact of a Multicenter Intervention To Improve the Quality and Efficiency of Pneumonia Care

Limited Impact of a Multicenter Intervention To Improve the Quality and Efficiency of Pneumonia Care

Relationship Between Organizational Factors and Performance Among Pay-for-Performance Hospitals

Duration of length of stay in pneumonia: influence of clinical factors and hospital type

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