Summaries for Patients |

Comparison of 3 Strategies To Improve the Care of Patients with Pneumonia Treated in the Emergency Department FREE

[+] Article, Author, and Disclosure Information

The summary below is from the full report titled “Effect of Increasing the Intensity of Implementing Pneumonia Guidelines. A Randomized, Controlled Trial.” It is in the 20 December 2005 issue of Annals of Internal Medicine (volume 143, pages 881-894). The authors are D.M. Yealy, T.E. Auble, R.A. Stone, J.R. Lave, T.P. Meehan, L.G. Graff, J.M. Fine, D.S. Obrosky, M.K. Mor, J. Whittle, and M.J. Fine.

Ann Intern Med. 2005;143(12):I-30. doi:10.7326/0003-4819-143-12-200512200-00002
Text Size: A A A

What is the problem and what is known about it so far?

Pneumonia is a lung infection. Most patients get better with antibiotics, but some develop serious complications or die. Factors that increase the chance of dying of pneumonia include older age, living in a nursing home, having other illnesses (especially cancer), and having certain abnormal physical examination or test results. Experts agree that patients at high risk for pneumonia complications should be hospitalized and patients at low risk should get treatment at home. Guidelines are recommendations for managing medical conditions that are based on studies that identify the types of care that work best. For pneumonia, 1 guideline identifies the types of patients who require hospitalization and those who can safely get treatment at home. Other guidelines recommend tests and treatments for patients with pneumonia. Unfortunately, many patients with pneumonia do not get treatment that agrees with guidelines. Hospitals are trying to identify strategies to improve pneumonia care.

Why did the researchers do this particular study?

To compare 3 strategies for improving pneumonia care.

Who was studied?

3219 patients with pneumonia who were seen in emergency departments at 32 hospitals in Pennsylvania and Connecticut.

How was the study done?

The researchers assigned hospitals to use 1 of 3 strategies to improve pneumonia care. A low-intensity strategy was used at 8 hospitals. This strategy gave hospitals information about their care of pneumonia patients in the previous year and asked each hospital to develop a plan to increase the number of patients who received care according to the pneumonia guidelines. A medium-intensity strategy was used at 12 hospitals. In addition to incorporating every element of the low-intensity strategy, this strategy required that the quality improvement plan 1) specify guidelines for appropriately assigning patients to the hospital or care at home and 2) require an educational session for medical care providers. The other 12 hospitals received a high-intensity strategy. This strategy incorporated the elements from the other 2 strategies plus 1-page reminders about the pneumonia guidelines. These reminders were delivered to doctors and nurses at the time of each patient's treatment, and caregivers gave feedback 1 week later about whether that patient's care agreed with the guidelines. The high-intensity sites also received instructions for conducting quality improvement projects and information on how well the site was doing with pneumonia care every 2 months.

The researchers collected information about the care and outcomes of patients with pneumonia treated at each of the emergency departments and compared the low-intensity, medium-intensity, and high-intensity groups.

What did the researchers find?

Both the moderate-intensity and high-intensity strategies increased the proportion of low-risk patients who received treatment at home. The high-intensity strategy resulted in the highest proportion of patients receiving care according to the recommendations, either treated at home or in the hospital.

What were the limitations of the study?

Many pneumonia patients seen in the 32 emergency departments during the study period did not participate. It is difficult to know which of the many components of the high-intensity strategy lead to the improvements.

What are the implications of the study?

To improve care of pneumonia, high-intensity quality improvement strategies appear to result in bigger improvements than less intense strategies.





Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).


Submit a Comment/Letter
Submit a Comment/Letter

Summary for Patients

Clinical Slide Sets

Terms of Use

The In the Clinic® slide sets are owned and copyrighted by the American College of Physicians (ACP). All text, graphics, trademarks, and other intellectual property incorporated into the slide sets remain the sole and exclusive property of the ACP. The slide sets may be used only by the person who downloads or purchases them and only for the purpose of presenting them during not-for-profit educational activities. Users may incorporate the entire slide set or selected individual slides into their own teaching presentations but may not alter the content of the slides in any way or remove the ACP copyright notice. Users may make print copies for use as hand-outs for the audience the user is personally addressing but may not otherwise reproduce or distribute the slides by any means or media, including but not limited to sending them as e-mail attachments, posting them on Internet or Intranet sites, publishing them in meeting proceedings, or making them available for sale or distribution in any unauthorized form, without the express written permission of the ACP. Unauthorized use of the In the Clinic slide sets will constitute copyright infringement.


Want to Subscribe?

Learn more about subscription options

Related Articles
Related Point of Care
Topic Collections
PubMed Articles
Forgot your password?
Enter your username and email address. We'll send you a reminder to the email address on record.