title: [Evaluation of clinical practice in patients admitted with community-acquired pneumonia over a 4-year period].
abstract: OBJECTIVE
  Since March 2000 we have been using a clinical practice guideline in the management of patients diagnosed with community-acquired pneumonia (CAP). The objective of this study was to analyze the evolution of quality of care received by these patients.
  
  
  METHODS
  This was a prospective observational study comparing the process of care and outcomes of 4 consecutive 1-year periods (March 1, 2000 through February 29, 2004) in patients admitted for CAP.
  
  
  RESULTS
  Over the 4 years studied, the following statistically significant trends were observed: reductions in hospital admissions (P< .001), length of hospital stay (P< .05), and total duration of antibiotic treatment (P< .05); and increases in the coverage of atypical pathogens (P< .001) and administration of antibiotics within 8 hours of hospital arrival (P< .001). No significant differences were found in readmissions within 30 days, or in-hospital and 30-day mortality. Two other areas for improvement were also identified: a low percentage of admissions to the intensive care unit (4.4%) and the rate of unnecessary hospitalization of low-risk patients (36.8%).
  
  
  CONCLUSIONS
  Systematic monitoring of the indicators of our clinical guidelines provided us with information about our clinical practice and facilitated an evaluation of the same. Many of these indicators were found to have evolved favorably and areas of improvement were identified.
authors.affiliation: Servicio de Neumología, Hospital de Galdakao, Vizcaya, España. acapelas@hgda.osakidetza.net
authors.forename: Alberto
authors.initials: A
authors.lastname: Capelastegui
authors.forename: Pedro P
authors.initials: PP
authors.lastname: España
authors.forename: José M
authors.initials: JM
authors.lastname: Quintana
authors.forename: Inmaculada
authors.initials: I
authors.lastname: Gorordo
authors.forename: Celia
authors.initials: C
authors.lastname: Sañudo
authors.forename: Amaia
authors.initials: A
authors.lastname: Bilbao
mesh_terms: D000368:Aged; D017714:Community-Acquired Infections / Q000628:therapy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D018410:Pneumonia, Bacterial / Q000628:therapy*; D011446:Prospective Studies; D013997:Time Factors