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Pneumonia Guidelines Cut Hospital Admissions

Multicenter study shows high-intensity focus on pneumonia guidelines improves care

TUESDAY, Dec. 20 (HealthDay News) -- An intense effort to have emergency department staff follow the recommended guidelines for treatment of pneumonia increases the number of low-risk patients who are treated as outpatients rather than being admitted to the hospital, according to a report in the Dec. 20 issue of the Annals of Internal Medicine.

Michael J. Fine, M.D., M.Sc., of the Veterans Administration Pittsburgh Healthcare System, led a large study team that randomized 32 hospital emergency departments in Pennsylvania and Connecticut to one of three programs designed to improve adherence to pneumonia treatment guidelines. Sites were designated as low-, moderate- or high-intensity intervention, which reflected the level of feedback, reinforcement and quality improvement activities conducted at the site.

A total of 3,219 patients diagnosed with pneumonia were treated at one of the emergency departments between January and December 2001. The investigators found that the moderate- and high-intensity emergency departments treated more low-risk patients as outpatients (61.9% high intensity, 61% moderate intensity, 37.5% low intensity) and more patients in the high-intensity group received the four recommended processes of care for pneumonia. No differences in safety were noted between the programs.

"Although the high-intensity intervention led to large relative improvements in the overall performance of the four recommended processes of care, only 61% of outpatients and 44% of inpatients had all processes completed," the authors write. "This finding reinforces the need for more potent quality improvement strategies for patients with pneumonia."

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