title: Impact of postgraduate education on physician practice for community-acquired pneumonia.
abstract: BACKGROUND
  Clinical practice guidelines on community-acquired pneumonia (CAP) are widely recognized by hospitals in Japan; however, little is known about the effect of postgraduate education on physicians' adherence to the guidelines or on patient outcomes.
  
  
  METHODS
  We conducted a chart review of inpatient CAP cases at a single teaching hospital in Japan from 2003 to 2005, during which the educational programme for residents was gradually reinforced by the introduction of multifaceted education and training in the management of infectious diseases. To assess the effects of this educational programme, we measured process indicators such as usage of diagnostic tests, choice of antibiotics, and clinical outcomes, including length of antibiotic treatment, length of stay, and mortality.
  
  
  RESULTS
  Several improvements were observed after educational intervention: (1) more frequent blood, sputum cultures, and Gram stain tests; (2) less frequent use of broad-spectrum antibiotics as the initial empiric therapy (from 50% to 12%) and on hospital day 5 (from 66.7% to 10%); and (3) median length of stay was shorter after intervention (16.5 days to 13 days).
  
  
  CONCLUSIONS
  Our findings suggest that multifaceted educational intervention for residents focused on diagnostic efforts, including Gram stain and cultures, choice of antibiotics with the appropriate spectrum, and de-escalation of antibiotics, can increase adherence to CAP guidelines as well as improve clinical outcomes.
authors.affiliation: Department of Primary Care and Emergency Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan. hikai-kyt@umin.net
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Ikai
authors.forename: Takeshi
authors.initials: T
authors.lastname: Morimoto
authors.forename: Takuro
authors.initials: T
authors.lastname: Shimbo
authors.forename: Yuichi
authors.initials: Y
authors.lastname: Imanaka
authors.forename: Kaoru
authors.initials: K
authors.lastname: Koike
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D017714:Community-Acquired Infections / Q000175:diagnosis* / Q000188:drug therapy* / Q000453:epidemiology; D004503:Education, Medical, Graduate; D005260:Female; D019983:Guideline Adherence; D007722:Health Knowledge, Attitudes, Practice; D017721:Hospital Costs; D017052:Hospital Mortality; D006801:Humans; D007396:Internship and Residency; D007564:Japan / Q000453:epidemiology; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D011014:Pneumonia / Q000175:diagnosis* / Q000188:drug therapy* / Q000453:epidemiology; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011787:Quality of Health Care; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents