title: Use of indicators to evaluate the quality of community-acquired pneumonia management.
abstract: Quality-assessment indicators for community-acquired pneumonia (CAP) founded on health care structure, process, and outcome have been recommended as a potential audit tool to evaluate the delivery of care. We prospectively audited the treatment of 205 patients admitted with CAP to 2 hospitals in Dundee against some of these key standards. Patients with severe CAP were more likely to die (mortality rate, 42% versus 7%) and to receive antibiotics by the intravenous route (relative risk [RR], 1.81; 95% confidence interval [CI], 1.38-2.37) and within 4 hours of admission to the hospital (RR, 1.22; 95% CI, 0.92-1.62). There was a lack of uniformity regarding the amount of oxygen prescribed, with evidence of poor case record and drug prescription chart documentation related to oxygen therapy. Adherence to the recommended antibiotic policy was associated with reduced risk of death or readmission to the hospital (RR, 0.58; 95% CI, 0.34-1.00). However, in a multivariate analysis, severity of pneumonia was the strongest predictor of death or readmission (P=.004), and adherence to the antibiotic policy was not statistically significant (P=.154). Our study has confirmed the value of quality indicators in evaluating our CAP management and has stimulated the development and implementation of a local hospital-based integrated care pathway.
authors.affiliation: Infection and Immunodeficiency Unit, Tayside University Hospitals Trust, Dundee, United Kingdom. nathwani@globalnet.co.uk
authors.forename: Dilip
authors.initials: D
authors.lastname: Nathwani
authors.forename: Fiona
authors.initials: F
authors.lastname: Williams
authors.forename: John
authors.initials: J
authors.lastname: Winter
authors.forename: Janet
authors.initials: J
authors.lastname: Winter
authors.forename: Simon
authors.initials: S
authors.lastname: Ogston
authors.forename: Peter
authors.initials: P
authors.lastname: Davey
mesh_terms: D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D003153:Community Health Services; D017714:Community-Acquired Infections / Q000188:drug therapy / Q000401:mortality; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010043:Outcome and Process Assessment, Health Care; D010349:Patient Compliance; D011014:Pneumonia / Q000188:drug therapy / Q000401:mortality; D011446:Prospective Studies; D011787:Quality of Health Care
chemical_list: D000900:Anti-Bacterial Agents