Community-acquired pneumonia: compliance with centers for Medicare and Medicaid services, national guidelines, and factors associated with outcome.
BACKGROUND
This study was performed to evaluate the impact of adherence to national guidelines for management of community-acquired pneumonia (CAP) on patient outcomes.


METHODS
Compliance with published national guidelines was assessed. Mortality rate and length of hospital stay were determined.


RESULTS
Patients who were administered antibiotics within 4 hours of admission had a shorter stay. Those treated at least 8 hours after admission had the highest mortality. Good compliance seen with 1998 guidelines of the Infectious Diseases Society of America declined substantially when 2000 Infectious Diseases Society of America guidelines were evaluated. Pediatric compliance was difficult to evaluate. Documentation of vaccination screening and administration was poor.


CONCLUSIONS
Antibiotic therapy should be started within 4 hours in patients with CAP. Using the most recent CAP guidelines as a benchmark may lower compliance unless providers are reeducated. National consensus guidelines for pediatric patients should be developed. Hospitals should evaluate documentation of vaccine screening and administration and should implement programs to increase vaccination rates if needed.
Department of Pharmacy Research, Keesler Medical Center, Keesler AFB, MS, USA. randy.ziss@keesler.af.mil
D Randall
DR
Ziss
Allan
A
Stowers
Carinda
C
Feild
D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D017714:Community-Acquired Infections / Q000401:mortality / Q000517:prevention & control*; D005260:Female; D019983:Guideline Adherence / Q000592:standards* / Q000706:statistics & numerical data; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008484:Medicaid / Q000592:standards* / Q000706:statistics & numerical data; D006278:Medicare / Q000592:standards* / Q000706:statistics & numerical data; D008875:Middle Aged; D017063:Outcome Assessment, Health Care / Q000592:standards* / Q000706:statistics & numerical data; D011014:Pneumonia / Q000401:mortality / Q000517:prevention & control*; D017410:Practice Guidelines as Topic / Q000592:standards*; D015996:Survival Rate; D014481:United States / Q000453:epidemiology