Robert M. Wachter, MD; Christopher Fee, MD; Scott A. Flanders, MD
Potential Financial Conflicts of Interest: None disclosed.
Wachter RM, Fee C, Flanders SA. The Unintended, Negative Consequences of the Door-to-Antibiotic Measure for Pneumonia. Ann Intern Med. 2009;150:220. doi: 10.7326/0003-4819-150-3-200902030-00017
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Published: Ann Intern Med. 2009;150(3):220.
We appreciate the letters, which endorse our main premise while adding new data and insights. Although we agree with most of the authors' points, we worry that the experience of a flawed measure, such as door-to-antibiotics for pneumonia, will lead some to throw out the baby (quality measurement and transparency) with the bathwater (the bad measure).
For example, Dr. Dean argues that the imposition of a national standard for pneumonia care undermined his organization's homegrown pneumonia strategy. We agree that national guidelines should provide enough flexibility to allow for individual institutional choice based on local factors, such as cost, resistance, and ease of administration, as long as the choices are compatible with the best evidence. In fact, Intermountain's preferred antibiotics were on the list of recommended antibiotics.
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