title: The HCAP gap: differences between self-reported practice patterns and published guidelines for health care-associated pneumonia.
abstract: BACKGROUND
  Health care-associated pneumonia (HCAP) is prevalent among hospitalized patients. In contrast to community-acquired pneumonia (CAP), patients with HCAP are at increased risk for multidrug-resistant organisms, and appropriate initial antibiotic therapy is associated with reduced mortality.
  
  
  METHODS
  An online survey was distributed to faculty and housestaff at 4 academic medical centers. The survey required respondents to choose initial antibiotic therapy for 9 hypothetical pneumonia cases (7 cases of HCAP and 2 cases of CAP). Answers were considered correct if the antibiotic regimen chosen was consistent with published guidelines. In addition, physicians rated their knowledge of current guidelines, as well as their level of agreement with guideline recommendations.
  
  
  RESULTS
  Surveys were sent to 1313 physicians with a response rate of 65% (n = 855). Respondents included physicians in the following categories: hospital medicine/internal medicine, 60%; emergency medicine, 25%; and critical care, 13%. Respondents selected guideline-concordant antibiotic regimens 78% of the time for CAP, but only 9% of the time for HCAP. Because mean scores for HCAP questions were extremely low (mean, 0.63 correct answers out of 7), differences in performance between groups were too small to be meaningful. Despite their poor performance, 71% of the respondents stated that they are aware of published guidelines for HCAP, and 79% stated that they agree with and practice according to the guidelines.
  
  
  CONCLUSIONS
  In this survey, physicians reported they were aware of, agreed with, and practiced according to published pneumonia guidelines; however, the overwhelming majority did not choose guideline-concordant therapy when tested.
authors.affiliation: Division of Hospital Medicine, Department of Medicine, University of California-San Diego, CA 92103-8485, USA. gseymann@ucsd.edu
authors.forename: Gregory B
authors.initials: GB
authors.lastname: Seymann
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Di Francesco
authors.forename: Bradley
authors.initials: B
authors.lastname: Sharpe
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Rohde
authors.forename: Peter
authors.initials: P
authors.lastname: Fedullo
authors.forename: Aaron
authors.initials: A
authors.lastname: Schneir
authors.forename: Christopher
authors.initials: C
authors.lastname: Fee
authors.forename: Kevin M
authors.initials: KM
authors.lastname: Chan
authors.forename: Pedram
authors.initials: P
authors.lastname: Fatehi
authors.forename: Thuy-Tien
authors.initials: TT
authors.lastname: Dam
mesh_terms: D000046:Academic Medical Centers; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D003428:Cross Infection / Q000188:drug therapy*; D006801:Humans; D011014:Pneumonia / Q000188:drug therapy*; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians'
chemical_list: D000900:Anti-Bacterial Agents