Hospital Quality Improvement Activities and the Effects of Interventions on Pneumonia: A Multistate Study of Medicare Beneficiaries

Abstract

This article evaluates the relative effectiveness of quality improvement interventions on increasing the time to antibiotic administration after a diagnosis of pneumonia. Clinical data were abstracted from the medical records of 17,040 Medicare beneficiaries discharged from one of 215 acute-care hospitals across 15 states. Thirteen Quality Improvement Organizations collected data on hospital quality improvement interventions from each hospital in this study. Medicare discharges between January 1997 and January 2002 define the study period. Most hospitals implemented multiple interventions to improve pneumonia care. Only 3 individual interventions were found to be effective in increasing time to antibiotic administration. Data feedback and benchmarking and medical records checklists had a positive effect on time to antibiotic administration. Administrative support by itself had a negative effect on the quality indicator. Although several combinations of interventions were also found effective, generalizations about the use of multiple interventions in quality improvement are difficult to make from retrospective studies.

Systematic review of safety checklists for use by medical care teams in acute hospital settings - limited evidence of effectiveness

“…Of these, 224 articles were retrieved for full text review and nine cohort studies with historical controls were included. Four clinical settings were covered, including five studies in the intensive care unit (ICU) [3-7]), two studies in the emergency department (ED) [8,9], one study in surgery [10], and one study in multi-departmental acute care [11]. Figure 1 shows the reasons for studies being excluded and included.…”

“…In Weingarten Jr et al 2004 [11], hospitals using a checklist administered appropriate antibiotics within eight hours for patients with pneumonia significantly more often than hospitals without the checklist (p = 0.0005). The OR was 1.993 (no CI reported) meaning that patients in hospitals using checklists were approximately twice as likely to receive appropriate antibiotics within eight hours compared patients in hospitals not using checklists.…”

“…It is also unclear how long after the introduction of the safety checklist outcome assessment should start. One study defined proper checklist use as being when the intervention had been implemented for 60 days [11]. This is an arbitrary point and it is unclear if the 60 day period after the implementation of the intervention can be validly used as a cut-off point.…”

Overcoming Barriers to Pneumococcal Vaccination in Patients With Pneumonia

“…The results of this study confirm previous observations that changes in provider behavior and organizational performance toward guideline adherence require a multipronged approach that includes education and systems approaches to changing processes of care. 13 The introduction of each intervention was associated with incremental improvement in performance from the baseline assessment rate of 0%: education alone increased rates to 35%, an intranet-based order form with decision support increased rates to 42%, and introduction of a standing order policy increased rates to 96%. These improvements were even more marked for patients older than 65 years with increases to 33%, 67%, and 100%, respectively for the 3 intervention periods.…”

“…In assessing hospitals' application of interventions to improve antibiotic selection for CAP, Weingarten and colleagues reported from a multistate Medicare database that most hospitals employ a single intervention (30%) or a combination of 2 interventions (18.5%). 13 Only 30.5% of hospitals used 4 or more interventions in combination to achieve improvements in performance. They noted that multiple interventions were more effective than any single intervention.…”