Medical Inspection – Health Blog

Baseline Evaluation

A total of 259 patients were included in the study, 134 patients in the pre-intervention group and 125 patients in the post-intervention group. The sex and age distributions of patients identified in the two groups are shown in Table 2.

Approximately 80% of the patients were older than 60 years of age (mean age, 74.8 years in the pre-intervention group and 73.5 years in the post-intervention group). No statistically significant differences in demographic covariates were found across the two treatment groups.

Table 2 Demographics of Patients with Community-Acquired Pneumonia

After the CAP guidelines were implemented, fewer patients in risk classes II and III were documented, although differences were not statistically significant. In addition, a greater number of patients in risk class IV were found in the post-intervention group.

Drug Therapy

A total of 334 anti-infective orders were documented in the pre-intervention group, and 284 orders were documented in the post-intervention group. The distribution of antibiotics by therapeutic class is provided in Table 3. The most commonly prescribed drug classes in the pre-intervention group were cephalosporins (38%), followed by fluoro-quinolones (30%). In the post-intervention group, fluoroquinolones (44%) were more commonly prescribed than cephalosporins (32%).

Table 3 Pharmacotherapy Distribution by Anti-infective Orders for Patients with Community-Acquired Pneumonia

Overall, the most common agent prescribed by route of administration in both groups was IV cefepime (Maxipime®, Elan) (23% and 27%, respectively). This was followed by oral ciprofloxacin (Cipro drug, Bayer) (12%) in the pre-intervention group and oral drug moxifloxacin (Avelox®, Bayer) (16%) in the post-intervention group. From a drug class perspective, the use of fluoro quinolones significantly increased after implementation of the guidelines (30% vs. 44%; P = .0003).

Figure 2 Percentage of patients receiving antibiotic therapy within two hours of anti-infective orders for the treatment of community-acquired pneumonia. Pre = pre-intervention; Post = post-intervention.

After the guidelines were implemented, 20% more patients received appropriate initial antibiotic therapy (67% in the pre-intervention group vs. 87% in the post-intervention group; P = .001). Fewer patients received three or more agents in the post-intervention group. In addition, significantly fewer patients had a documented change in the therapeutic dose in the post-intervention group than in the pre-intervention group (24.8% vs. 38.1°%, respectively; P = .0219).

Figure 3 Mean and overall length of hospital stay by risk class for patients with community-acquired pneumonia. Pre = pre-intervention; Post = post-intervention.

The average length of time to antibiotic administration was 3.6 hours for the pre-intervention group and 3.4 hours for the post-intervention group. As shown in Figure 2, 19% more patients in the post-intervention group received an antibiotic within two hours after the antibiotic was ordered (P = .0002).

Length of Stay

The overall LOS (Figure 3) decreased by one day in the post-intervention group. This reduction was determined to be statistically significant even after differences were accounted for across the two cohorts and even with potential confounding variables. Further analysis indicated that the average LOS decreased in all risk classes, except risk class III in the post-intervention group. Patients in risk class IV experienced in the largest decrease in LOS: from 5.8 to 4.0 days.

Table 4 Total Charges for the Pre-intervention and Post-intervention Study Patients with Community-Acquired Pneumonia

The percentage of patients requiring treatment in the intensive-care unit was equivalent in both groups, and more than 90% of the patients in this study did not have a documented hospitalization within 30 days of the initial hospi-talization (readmission). A total of 15 patients—five (3.7%) in the pre-intervention group and 10 (8%) in the post-intervention group—were readmitted, but differences across the cohorts were not significant.

Economic Analysis

The unadjusted mean hospital-ization charges (Table 4) were $829 lower in the post-intervention group; however, this difference, although potentially financially significant, was not statistically significant. Patient charges were 35.1% higher in risk class V than those in risk class II (P = .044). The charges for patients with chronic obstructive pulmonary disease (COPD) were 15.3% higher than for patients who did not have COPD. The overall reduction in the amount of dollars charged was approximately $205,000 in constant 1999 dollars.

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