Determining best outcomes from community‐acquired pneumonia and how to achieve them

Abstract

Community-acquired pneumonia (CAP) is a common acute medical illness with a standard, effective treatment that was introduced before the evidenced-based medicine era. Mortality rates have improved in recent decades but improvements have been minimal when compared to other conditions such as acute coronary syndromes. The standardized approach to treatment makes CAP a target for comparative performance and outcome measures. While easy to collect, simplistic outcomes such as mortality, readmission and length of stay are difficult to interpret as they can be affected by subjective choices and health care resources. Proposed clinical-and patient-reported outcomes are discussed below and include measures such as the time to clinical stability (TTCS) and patient satisfaction, which can be compared between health institutions. Strategies to improve these outcomes include use of a risk stratification tool, local antimicrobial guidelines with antibiotic stewardship and care bundles to include early administration of antibiotics and early mobilization.

Community-Acquired Pneumonia

“…58,59 Primary care providers should ensure that after a pneumonia diagnosis patients receive aspirin and statin if they are eligible. 60,61…”

Contemporary Concise Review 2018: Respiratory infections and tuberculosis

“…The standardized approach to treatment makes CAP a target for comparative performance and outcome measures. Hadfield and Bennet discussed clinical‐ and patient‐reported outcomes, including endpoints such as the time to clinical stability and patient satisfaction, and strategies to improve these outcomes including use of a risk stratification tool, local antimicrobial guidelines with antibiotic stewardship and care bundles to include early administration of antibiotics and early mobilization. Interestingly, the provision of procalcitonin assay results to emergency department and hospital‐based clinicians did not result in less use of antibiotics than did usual care among patients with suspected lower RTI in a randomized controlled trial (RCT) involving 14 hospital sites in the USA …”

Patient-reported outcome measures in community-acquired pneumonia: a systematic review of application and content validity

“…The significance of this illness, in terms of both morbidity and health service cost, promotes a degree of urgency for the establishment of a robust outcome framework to both understand the health gains produced and the value associated with care. Consensus on the outcomes of most importance in CAP is lacking, and ongoing debate has failed to resolve the question of the appropriateness of various clinical and patient-centred measures 33 34. PROMs are often overlooked in favour of objective clinical measures such as mortality or time to clinical stability which do not necessarily reflect the outcomes of most value to the patient 4.…”