Clinical pathway care improves outcomes among patients hospitalized for community-acquired pneumonia.
OBJECTIVE
To examine the impact of a unique evidence-based clinical pathway on six outcomes of care in patients hospitalized for community-acquired pneumonia (CAP).


METHODS
A retrospective cohort study of CAP patients discharged between January 1999 and December 2001, from 31 Adventist Health System institutions nationwide. A total of 22,196 records were available for multivariate analyses. Odds ratios (OR) for the outcomes were calculated and stratified by a unique severity score. The severity score ranged from 1 to 5, where 5 indicated the most severe condition.


RESULTS
Pathway patients were significantly less likely to die in-hospital compared with non-pathway patients in four of the five severity strata (OR in severity level 1=0.37; 95% confidence interval [CI], 0.20-0.70). In all severity strata, pathway patients were approximately twice as likely as non-pathway patients to receive blood cultures and appropriate antibiotic therapy. Among patients who were classified as severity level 1, pathway patients experienced an 80% reduction in the odds of respiratory failure requiring mechanical ventilation (OR=0.20; 95% CI, 0.12-0.33).


CONCLUSIONS
Patients who were placed on pneumonia clinical pathway care were much more likely than non-pathway patients to have favorable outcomes of care.
Hauck
Loran D
LD
Adventist Health System, Orlando, FL, USA.
Adler
Lee M
LM
Mulla
Zuber D
ZD
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017714:Community-Acquired Infections / Q000401:mortality / Q000628:therapy*; D019091:Critical Pathways; D019317:Evidence-Based Medicine; D005260:Female; D019983:Guideline Adherence; D017052:Hospital Mortality; D016519:Hospitals, Religious / Q000592:standards*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009096:Multi-Institutional Systems / Q000592:standards; D010043:Outcome and Process Assessment, Health Care; D011014:Pneumonia / Q000401:mortality / Q000628:therapy*; D011785:Quality Assurance, Health Care; D012189:Retrospective Studies; D014481:United States / Q000453:epidemiology