Improvement of Process‐of‐Care and Outcomes after Implementing a Guideline for the Management of Community‐Acquired Pneumonia: A Controlled Before‐and‐After Design Study

Capelastegui, Alberto; España, Pedro Pablo; Quintana, José M.; Gorordo, Inmaculada; Ortega, Mar; Idoiaga, Itsaso; Bilbao, Amaia

doi:10.1086/423960

Cited by 125 publications

(88 citation statements)

References 30 publications

(60 reference statements)

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“…This suggests that treatment-related factors, such as timeliness of antibiotic administration and choice of drug, may have an influence on prognosis. Indeed, some data in the literature suggest that treatment conforming to guidelines is associated with a better outcome [36,37]. In a recent study on hospitalised CAP patients, ROSÓ N et al [16] focused on the causes of early failure, and found that a proportion of these cases were associated with discordant therapy, which may be preventable by a rational application of treatment guidelines.…”

Section: Discussionmentioning

confidence: 99%

Outcome of community-acquired pneumonia: influence of age, residence status and antimicrobial treatment

Kothe

Bauer²,

Marre³

et al. 2008

European Respiratory Journal

168

103

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Community-acquired pneumonia remains a major cause of mortality in developed countries. There is much discrepancy in the literature regarding factors influencing the outcome in the elderly population.Data were derived from a multicentre prospective study initiated by the German Competence Network for Community-Acquired Pneumonia. Patients with community-acquired pneumonia (n52,647; 1,298 aged ,65 yrs and 1,349 aged o65 yrs) were evaluated, of whom 72.3% were hospitalised and 27.7% treated in the community. Clinical history, residence status, course of disease and antimicrobial treatment were prospectively documented. Microbiological investigations included cultures and PCR of respiratory samples and blood cultures. Factors related to mortality were included in multivariate analyses.The overall 30-day mortality was 6.3%. Elderly patients exhibited a significantly higher mortality rate that was independently associated with the following: age; residence status; confusion, urea, respiratory frequency and blood pressure (CURB) score; comorbid conditions; and failure of initial therapy. Increasing age remained predictive of death in the elderly. Nursing home residents showed a four-fold increased mortality rate and an increased rate of Gram-negative bacillary infections compared with patients dwelling in the community. The CURB score and cerebrovascular disease were confirmed as independent predictors of death in this subgroup.Age and residence status are independent risk factors for mortality after controlling for comorbid conditions and disease severity. Failure of initial therapy was the only modifiable prognostic factor.

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Section: Discussionmentioning

confidence: 99%

Outcome of community-acquired pneumonia: influence of age, residence status and antimicrobial treatment

Kothe

Bauer²,

Marre³

et al. 2008

European Respiratory Journal

168

103

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“…It has recently been shown that implementing a guideline for the management of patients hospitalised for the treatment of CAP significantly improves the process-of-care and outcomes [24]. Others have demonstrated similar improvements [25][26][27].…”

mentioning

confidence: 98%

Validation of a predictive rule for the management of community-acquired pneumonia

Capelastegui

España²,

Quintana³

et al. 2006

European Respiratory Journal

321

213

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The CURB-65 score (Confusion, Urea .7 mmol?L -1 , Respiratory rate o30?min, low Blood pressure, and age o65 yrs) has been proposed as a tool for augmenting clinical judgement for stratifying patients with community-acquired pneumonia (CAP) into different management groups.The six-point CURB-65 score was retrospectively applied in a prospective, consecutive cohort of adult patients with a diagnosis of CAP seen in the emergency department of a 400-bed teaching hospital from March 1, 2000 to February 29, 2004. A total of 1,100 inpatients and 676 outpatients were included.The 30-day mortality rate in the entire cohort increased directly with increasing CURB-65 score: 0, 1.1, 7.6, 21, 41.9 and 60% for CURB-65 scores of 0, 1, 2, 3, 4, and 5, respectively. The score was also significantly associated with the need for mechanical ventilation and rate of hospital admission in the entire cohort, and with duration of hospital stay among inpatients.The CURB-65 score (Confusion, Urea .7 mmol?L -1, Respiratory rate o30?min, low Blood pressure, and age o65 yrs), and a simpler CRB-65 score that omits the blood urea measurement, helps classify patients with community-acquired pneumonia into different groups according to the mortality risk and significantly correlates with community-acquired pneumonia management key points. The new score can also be used as a severity adjustment measure.

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“…A change in outcome(s) from preintervention to postintervention in the intervention site but not the control site provides evidence that the effect is due to the intervention. For example, the impact of the implementation of a hospital guideline for management of patients with community-acquired pneumonia was compared between an intervention hospital and four randomly selected control hospitals (14). Data on processes of care and outcomes for patients with community-acquired pneumonia were abstracted from medical records for 12 months prior to the guideline implementation and 19 months after its implementation.…”

Section: Controlled Prepost Designsmentioning

confidence: 99%

Evaluation of Systems-Oriented Public Health Interventions: Alternative Research Designs

Sanson‐Fisher

DʼEste

Carey

et al. 2014

Annu. Rev. Public Health

121

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Keywordscluster randomized controlled trial, stepped wedge design, interrupted time series, multiple baseline design, controlled prepost design AbstractThe need to provide sound evidence of the costs and benefits of real-world public health interventions has driven advances in the development and analysis of designs other than the controlled trial in which individuals are randomized to an experimental condition. Attention to methodological quality is of critical importance to ensure that any evaluation can accurately answer three fundamental questions: (a) Has a change occurred, (b) did the change occur as a result of the intervention, and (c) is the degree of change significant? A range of alternatives to the individual randomized controlled trial (RCT) can be used for evaluating such interventions, including the cluster RCT, stepped wedge design, interrupted time series, multiple baseline, and controlled prepost designs. The key features and complexities associated with each of these designs are explored.

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Improvement of Process‐of‐Care and Outcomes after Implementing a Guideline for the Management of Community‐Acquired Pneumonia: A Controlled Before‐and‐After Design Study

Abstract: This study, which was performed with an adequate, controlled before-and-after intervention design, demonstrated significant improvements in both process-of-care and outcome indicators after implementation of a guideline for treating CAP.

Cited by 125 publications

References 30 publications

Outcome of community-acquired pneumonia: influence of age, residence status and antimicrobial treatment

Outcome of community-acquired pneumonia: influence of age, residence status and antimicrobial treatment

Validation of a predictive rule for the management of community-acquired pneumonia

Evaluation of Systems-Oriented Public Health Interventions: Alternative Research Designs

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