Community-acquired pneumonia: defining quality care.
BACKGROUND
Community-acquired pneumonia (CAP) is one of 3 initial conditions for which the Joint Commission for Accreditation of Healthcare Organizations and the Centers for Medicare & Medicaid Services have defined quality measures. Eight "core measures" of pneumonia care have been targeted for reporting by U.S. hospitals to facilitate performance monitoring.


METHODS
A review of the literature supporting the core measures was performed.


RESULTS
Indicators encouraging influenza vaccination and appropriate antibiotic selection had the most robust evidence. Rapid delivery of antibiotics also showed significant reduction in mortality, though the actual timing (4 versus 8 hours) varied between studies. Other measures, such as performance of blood cultures, pneumococcal vaccination, smoking cessation, and oxygenation assessment, demonstrated less obvious clinical benefit.


CONCLUSIONS
There is inherent value in setting standards of care for high-impact conditions such as CAP, but these standards should be chosen on the basis of high-quality research. Public reporting of the current measures is problematic, as it implies they represent best practices for CAP despite relatively weak evidence.
Seymann
Gregory B
GB
Division of Hospital Medicine, Department of Medicine, University of California, San Diego, School of Medicine, San Diego, California 92103-8485, USA. gseymann@ucsd.edu
D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D017714:Community-Acquired Infections / Q000188:drug therapy; D003428:Cross Infection / Q000188:drug therapy* / Q000209:etiology / Q000517:prevention & control; D017052:Hospital Mortality; D006801:Humans; D007902:Length of Stay; D015337:Multicenter Studies as Topic; D022242:Pneumococcal Vaccines; D011014:Pneumonia / Q000188:drug therapy* / Q000209:etiology / Q000517:prevention & control; D011787:Quality of Health Care / Q000592:standards*; D012189:Retrospective Studies; D012720:Severity of Illness Index
D000900:Anti-Bacterial Agents; D022242:Pneumococcal Vaccines