title: Which strategies facilitate improvement in quality of care for elderly hospitalized pneumonia patients?
abstract: BACKGROUND
  A retrospective cohort study was conducted to elucidate which hospital-based quality improvement (QI) strategies are most effective in facilitating improvement in care for patients with community-acquired pneumonia.
  
  
  METHODS
  In 1999 telephone interviews were conducted with 29 acute care hospitals in Connecticut regarding their use of QI strategies for 1,234 patients at baseline and 1,081 patients at follow-up.
  
  
  RESULTS
  Hospital-based QI strategies were grouped into two domains of implementation approach (epidemiologic and social influence). Hospitals scoring a 4 in either the epidemiologic or social influence approach (versus a score of < or = 3) experienced a greater-than-average increase in percentage of patients with blood culture collection within 24 hours of hospital presentation. Hospitals applying all four social influence QI strategies showed a greater-than-average increase in delivery of antibiotics within 8 hours of patients' hospital arrival when compared with all the other hospitals combined.
  
  
  CONCLUSIONS
  The finding that an increased proportion of patients receiving antibiotics within 8 hours and blood cultures within 24 hours of hospital arrival when the greatest numbers of hospital-based QI strategies were implemented in suggestive of a possible "dose effect" of QI.
authors.affiliation: Division of Pulmonary and Critical Care Medicine, Cedars-Sinai Medical Center, Los Angeles, USA.
authors.forename: George S
authors.initials: GS
authors.lastname: Tu
authors.forename: Thomas P
authors.initials: TP
authors.lastname: Meehan
authors.forename: Jonathan M
authors.initials: JM
authors.lastname: Fine
authors.forename: Yun
authors.initials: Y
authors.lastname: Wang
authors.forename: Eric S
authors.initials: ES
authors.lastname: Holmboe
authors.forename: Zab
authors.initials: Z
authors.lastname: Mohsenifar
authors.forename: Scott R
authors.initials: SR
authors.lastname: Weingarten
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D017714:Community-Acquired Infections / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology; D003237:Connecticut / Q000453:epidemiology; D019091:Critical Pathways; D019983:Guideline Adherence; D006302:Health Services Research; D006764:Hospitals, Community / Q000592:standards*; D006801:Humans; D033181:Information Dissemination; D033183:Interdisciplinary Communication; D019982:Organizational Case Studies; D010043:Outcome and Process Assessment, Health Care; D018962:Phlebotomy; D011014:Pneumonia / Q000175:diagnosis* / Q000188:drug therapy* / Q000453:epidemiology; D013997:Time Factors; D017749:Total Quality Management / Q000379:methods*
chemical_list: D000900:Anti-Bacterial Agents