The effectiveness of national guidelines on the outcomes of patients with community acquired pneumonia.

摘要

To improve the quality of health care in the United States, policy-makers from professional medical organizations and the Agency for Healthcare Research and Quality (AHRQ) have endorsed the use of evidence-based guidelines. The Infectious Disease Society of America (IDSA) has published its most recent guidelines for diagnosis and treatment of community-acquired pneumonia (CAP). They include antibiotic recommendations and the severity model developed by Fine et. al. A national CAP Benchmark Database containing treatment and outcome data for 56 hospitals was analyzed to determine the effectiveness of guidelines. Data were evaluated to determine if outcomes for lower-risk patients (Classes I–III) treated with IDSA recommended antibiotics differed from those who received alternative antibiotics. Enrolled patients had at least two of the following: cough, fever, leukocytosis with left shift, plus evidence of infiltrates on chest radiograph. A total of 1,265 patients met inclusion criteria and were considered to be lower-risk. Of these, 686 (41.6%) were treated with IDSA recommended antimicrobials and the remaining 963 received alternative therapies either alone or in addition to recommended therapy. Patients treated according to IDSA guidelines were comparable in terms of severity of illness, including age, symptoms and comorbid illnesses. Patients treated according to guidelines had shorter hospital LOS than those that were not, 4.7, verus 4.2 days, respectively (p 0.001). LOS was shorter for patients treated according to the IDSA guidelines when the data were analyzed by risk category: 3.3 days vs. 3.5 days (p = ns) for category I, 4.1 days vs. 4.6 days for category II (p 0.01), and 4.5 days vs. 5.1 days (p 0.01) for category III. Readmission and mortality were lower in the IDSA group, however this was not statistically significant (2.7% vs. 3.7% readmissions) and (0.4% vs. 0.6%, deaths). Using antimicrobials recommended by IDSA significantly decreases length of stay in the hospital and although not statistically significant, may also lower readmission rates and mortality.