Implementation of an inpatient management and discharge strategy for patients with community-acquired pneumonia.
OBJECTIVE
To assess the effectiveness and safety of implementing an inpatient management and discharge strategy based on empiric antibiotic therapy with ceftriaxone sodium and a guideline to promote timely discharge for clinically stable patients hospitalized with community-acquired pneumonia.


METHODS
A cluster randomized controlled clinical trial with 30 days of patient follow-up at 8 teaching hospitals and 17 nonteaching hospitals nationwide.


METHODS
Participants included 240 intervention patients and 209 control patients admitted by 85 physician groups between December 1998 and December 1999. Within each hospital, defined physician practice groups were randomized to the intervention arm (physician notification coupled with ceftriaxone sodium as empiric therapy) or control arm (neither component). Physicians in the intervention arm were notified when their patients met guideline criteria for clinical stability; physicians in the control arm were not contacted.


RESULTS
The median length of stay was 4 days in both study arms. The observed reduction in costs associated with the intervention was not statistically significant when cost outliers were excluded. Mortality, serious adverse event, and rehospitalization rates did not differ significantly across study arms.


CONCLUSIONS
Implementation of an inpatient management strategy based on physician reminders coupled with empiric use of ceftriaxone sodium did not reduce length of stay or associated medical care costs for patients hospitalized with community-acquired pneumonia. These negative findings are most likely due to insufficient potency of the intervention, inadequate guideline implementation, or imbalances in baseline patient characteristics.
Stone
Roslyn A
RA
Department of Biostatistics, Graduate School of Public Health, University of Pittsburgh, 304 Parran Hall, Pittsburgh, PA 15261, USA. roslyn@pitt.edu
Mor
Maria K
MK
Lave
Judith R
JR
Hough
Linda J
LJ
Fine
Michael J
MJ
D000293:Adolescent; D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D002443:Ceftriaxone / Q000627:therapeutic use*; D017714:Community-Acquired Infections / Q000188:drug therapy*; D019468:Disease Management; D005260:Female; D017408:Guidelines as Topic; D006801:Humans; D007297:Inpatients; D008297:Male; D008875:Middle Aged; D010351:Patient Discharge; D018410:Pneumonia, Bacterial / Q000188:drug therapy*; D014481:United States
D000900:Anti-Bacterial Agents; D002443:Ceftriaxone