title: Shoot, ready, aim: pneumonia care quality and costs in a community hospital.
abstract: Mandatory community-acquired pneumonia (CAP) protocol usage was proposed in our community-based teaching hospital because of senior medical staff perceptions that excessive variation in CAP care was adversely affecting clinical outcomes and costs. The purpose of our study was to examine CAP process of care variation, outcomes, and costs to ascertain whether the mandatory CAP protocol could be justified. The study consisted of an analysis of administrative and sampled chart data. We looked at pneumonia severity, orders for blood cultures or sputum staining, antibiotic usage, symptom resolution, length of stay, discharge status, readmission risk by follow-up time, and financial data. We found that process of care variation was low, clinical outcomes were generally good, and CAP care was profitable. Our data suggested that the proposed mandatory CAP protocol was not necessary. Our experience supports the management principle that fact finding should usually precede decision making, not the reverse.
authors: Department of Family Practice, Summa Health System, 525 East Market Street, Suite 290, PO Box 2090, Akron, OH 44309-2090, USA. milol@summa-health.org
authors: Lori A
authors: LA
authors: Milo
authors: William
authors: W
authors: Smucker
authors: Everett
authors: E
authors: Logue
authors: James
authors: J
authors: Orosz
authors: Michael G
authors: MG
authors: Grimes
authors: Bonyo
authors: B
authors: Bonyo
authors: David
authors: D
authors: Dulle
authors: Marc
authors: M
authors: McNaughton
mesh_terms: D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D017714:Community-Acquired Infections / Q000188:drug therapy / Q000191:economics; D019091:Critical Pathways / Q000592:standards; D005260:Female; D006746:Hospital Bed Capacity, 500 and over; D017721:Hospital Costs; D006764:Hospitals, Community; D006801:Humans; D007902:Length of Stay; D008297:Male; D010043:Outcome and Process Assessment, Health Care / Q000379:methods; D005791:Patient Care / Q000191:economics*; D018410:Pneumonia, Bacterial / Q000188:drug therapy* / Q000191:economics*; D011785:Quality Assurance, Health Care / Q000191:economics / Q000379:methods*
chemical_list: D000900:Anti-Bacterial Agents