title: Assessing Compliance With Established Pneumonia Core Measures at a Comprehensive Cancer Center.
abstract: Healthcare organizations use Pneumonia Core Measures (PCMs) to ensure delivery of high-quality care. In this study, a multidisciplinary team was organized to optimize care and enhance compliance in a comprehensive cancer emergency center. We performed a four-phase study, three of which were interventional: intense education regarding PCM; microbiologic analysis of the pathogens responsible for the pneumonias; development and implementation of an institutional pneumonia algorithm and order set. In phase 4, we analyzed five PCMs. The percentage of pneumonia patients from whom blood cultures were obtained increased from 73% to 91% after intervention (p < .001); sputum cultures increased from baseline 24.6% to 51% (p = .004) post order-set implementation, and order-set utilization increased from 40% to 77%. We achieved the benchmark for only one PCM, PN 3a. More than 80% of patients met clinical and microbiological criteria for healthcare-associated pneumonia. We identified a gap between our patient population and some PCMs that relates to antibiotics selection. The treatment of cancer patients and pneumonia falls outside established guidelines for treating community-acquired pneumonia. Although the algorithm and order set implemented optimized care and minimized variation, national benchmarks for four of the PCMs were not met. Our findings provide information for policymakers considering pneumonia measurements for antibiotic selection in a cancer care setting.
authors.forename: Carmen Esther
authors.initials: CE
authors.lastname: Gonzalez
authors.forename: Tami N
authors.initials: TN
authors.lastname: Johnson
authors.forename: Scott
authors.initials: S
authors.lastname: Evans
authors.forename: Lisa M
authors.initials: LM
authors.lastname: Kidin
authors.forename: Sobha
authors.initials: S
authors.lastname: George
authors.forename: Samir
authors.initials: S
authors.lastname: Haq
authors.forename: Alma Yvette
authors.initials: AY
authors.lastname: DeJesus
authors.forename: Ronald
authors.initials: R
authors.lastname: Walters
authors.forename: Kenneth
authors.initials: K
authors.lastname: Rolston
mesh_terms: D000328:Adult; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D019985:Benchmarking / Q000592:standards; D001769:Blood / Q000382:microbiology; D002173:Cancer Care Facilities / Q000592:standards; D004636:Emergency Service, Hospital / Q000458:organization & administration / Q000592:standards*; D019983:Guideline Adherence; D006801:Humans; D007049:Iatrogenic Disease; D009369:Neoplasms / Q000150:complications; D011014:Pneumonia / Q000175:diagnosis / Q000188:drug therapy* / Q000382:microbiology; D019984:Quality Indicators, Health Care / Q000706:statistics & numerical data; D013183:Sputum / Q000382:microbiology; D013781:Texas
chemical_list: D000900:Anti-Bacterial Agents