A controlled trial of a critical pathway for treating community-acquired pneumonia: the CAPITAL study. Community-Acquired Pneumonia Intervention Trial Assessing Levofloxacin.
Recent clinical trials in patients with community-acquired pneumonia (CAP) demonstrated that switching from intravenous to oral antibiotic therapy is safe once clinical improvement is evident, thereby facilitating early hospital discharge. This study evaluated the use of a critical pathway to improve the efficiency of treating CAP in 1743 patients at 19 teaching and community hospitals in Canada. Hospitals were randomized to continue conventional management of CAP (10 hospitals) or implement a critical pathway (9 hospitals). The main clinical outcome measure was patients' scores (assessed 6 wks after hospital presentation) on the Short-Form 36 Physical Component Summary, a quality-of-life questionnaire. Secondary clinical outcome measures included occurrence of complications, readmission rates, and mortality. The primary economic outcome measure was resource utilization, measured by the number of bed days/patient managed (BDPM). Clinical outcomes were good in both groups, with no significant differences between the two management strategies. However, use of the clinical pathway was associated with a 1.7-day reduction in BDPM and fewer admissions of low-risk patients.
Feagan
B G
BG
University of Western Ontario, Robarts Research Institute, London, Canada.
D000284:Administration, Oral; D000328:Adult; D000890:Anti-Infective Agents / Q000008:administration & dosage* / Q000191:economics / Q000627:therapeutic use; D002170:Canada; D017714:Community-Acquired Infections / Q000145:classification / Q000188:drug therapy* / Q000191:economics; D019091:Critical Pathways / Q000191:economics*; D006760:Hospitalization / Q000191:economics*; D006801:Humans; D007275:Injections, Intravenous; D007902:Length of Stay / Q000191:economics; D064704:Levofloxacin; D015242:Ofloxacin / Q000008:administration & dosage* / Q000191:economics / Q000627:therapeutic use; D011014:Pneumonia / Q000145:classification / Q000188:drug therapy* / Q000191:economics; D011788:Quality of Life; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires; D016896:Treatment Outcome
D000890:Anti-Infective Agents; D064704:Levofloxacin; D015242:Ofloxacin