A prospective, multicenter study of a pneumonia practice guideline.
OBJECTIVE
To study the effect of a length of stay practice guideline on patient outcomes.


METHODS
A prospective, nonrandomized, interventional trial.


METHODS
Six geographically distributed hospitals.


METHODS
Two hundred forty-two consecutively hospitalized "low-risk" patients with pneumonia.


RESULTS
One hundred fifty-two patients (63%) completed the mailed postdischarge survey and were included in the analysis. Data were prospectively collected for 85 patients from the baseline observation period (B) and 67 patients from the intervention period (I). During the I, case managers provided physicians with patient risk information based on guideline recommendations. There was no significant change in guideline compliance (B vs I: 76.5% vs 83.6%; p=0.32) or length of stay (B vs I: 3.5 days [95% confidence interval, 3.2 to 3.8] vs 3.6 days [95% confidence interval, 3.3 to 4.0]). Also, there were no statistically significant effects of the intervention on patient outcomes, care following hospital discharge, and patient satisfaction scores.


CONCLUSIONS
Patients in this study often had shorter lengths of stay than recommended by the practice guideline. This suggests that the external environment may have had a greater effect on physician behavior and length of stay than the practice guideline itself. Moreover, it demonstrates the importance of continuous assessment of physician practices immediately prior to, during, and after application of the clinical practice guideline.
Rhew
D C
DC
Department of Health Services Research, UCLA School of Medicine, Los Angeles, CA, USA.
Riedinger
M S
MS
Sandhu
M
M
Bowers
C
C
Greengold
N
N
Weingarten
S R
SR
D000203:Activities of Daily Living; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000627:therapeutic use; D019090:Case Management; D016001:Confidence Intervals; D005260:Female; D006760:Hospitalization; D006801:Humans; D007902:Length of Stay; D008297:Male; D008485:Medical Audit; D008875:Middle Aged; D010351:Patient Discharge; D010359:Patient Readmission; D017060:Patient Satisfaction; D011014:Pneumonia / Q000188:drug therapy* / Q000451:nursing; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians'; D011446:Prospective Studies; D011788:Quality of Life; D012307:Risk Factors; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents