Clinical studyA statewide initiative to improve the care of hospitalized pneumonia patients: the Connecticut Pneumonia Pathway Project☆
Section snippets
Collaboration
This collaboration took place in Connecticut from 1996 to 1997, when the Connecticut Thoracic Society and Qualidigm (the Connecticut Peer Review Organization) decided to conduct a statewide initiative to improve the care of hospitalized pneumonia patients by increasing the performance of evidence-based processes of care. Because many Connecticut hospitals were developing critical pathways to standardize process-of-care performance and to decrease length of stay, the Thoracic Society decided to
Results
There were 2,200 (20.3%) patients with a discharge diagnosis of pneumonia selected for abstraction from 10,843 total cases during the baseline period, and 2,014 (34.9%) patients selected from 5,768 total cases during the follow-up period. The range of sampling fractions per hospital was 8.1% to 56.9% during the baseline period and 13.3% to 100.0% during the follow-up period. Case confirmation (83.9% vs. 83.9%, P = 1.0) and exclusion rates (34.9% vs. 34.8%, P = 0.95) were similar in both
Discussion
In this statewide quality improvement initiative, we observed that a multifaceted improvement intervention was accompanied by increases in process-of-care performance. Consistent with our study’s focus on processes of care, we observed an increase in receipt of antibiotics within 8 hours of hospital arrival and a decrease in median time to initial antibiotics. Performance of oxygenation assessments within 24 hours of hospital arrival and blood culture collection before antibiotic administration
Acknowledgements
The authors would like to acknowledge Kelly Forsyth and Amy Morrissey for their administrative support in preparing the manuscript.
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Dr. Fine was supported in part by a grant from the Polly Annenberg Levee Charitable Trust, Washington, DC. The analyses upon which this publication is based were performed under Contract Number 500-96-P549, entitled “Utilization and Quality Control Peer Review Organization for the State of Connecticut,” sponsored by the Centers for Medicine and Medicinal Services (CMS), Department of Health and Human Services. The content of this publication does not necessarily reflect the views or policies of the U.S. Department of Health and Human Services nor does mention of trade names, commercial products, or organizations imply endorsement by the U.S. government. The authors assume full responsibility for the accuracy and completeness of the ideas represented. This article is a direct result of the Health Care Quality Improvement Program initiated by the CMS, which has encouraged identification of quality improvement projects derived from analysis of patterns of care, and therefore required no special funding on the part of the contractor. Ideas and contributions are welcomed by the authors concerning experience with the issues presented.