Brief observation
Effects of a practice guideline for community-acquired pneumonia in an outpatient setting

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Methods

A multidisciplinary team developed the practice guideline, which directed specific antibiotic choices and hospital admission based on severity assessment (11). Our guideline followed 1993 American Thoracic Society recommendations. The study sample included consecutive immunocompetent pneumonia patients ≥18 years old, treated at four Instacares, which are high-volume, urgent care clinics that are staffed to provide acute walk-in care 14 hours daily (no ambulance or long-term care facility

Results

Four hundred sixty-three patients were identified: 199 before guideline implementation (control period) and 264 after guideline implementation (intervention period). The practice guideline form was completed for 238 of 264 (90%) patients. Age, sex, smoking history, pneumonia severity index, pneumonia severity index risk class, and number of risk factors did not differ between the groups (Table 1).

The rate of hospital admission was twice as great during the control period (14% versus 6%, P =

Discussion

After implementation of a pneumonia guideline, the hospital admission rate for patients with community-acquired pneumonia seen at three urgent care clinics decreased without a detectable difference in baseline severity of illness. While the focus of the guideline was quality of care, it also resulted in substantial cost savings. Saving $45 per patient for antibiotic therapy amounts to $135 million if extrapolated to the estimated 3 million outpatients with pneumonia treated annually in the

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References (13)

  • M.J. Fine

    Hospitalization decision in patients with community-acquired pneumoniaa prospective cohort study

    Am J Med

    (1990)
  • M.S. Niederman et al.

    The cost of treating community-acquired pneumonia

    Clin Ther

    (1998)
  • S.J. Atlas et al.

    Safely increasing the proportion of patients with community-acquired pneumonia treated as outpatients

    Arch Intern Med

    (1998)
  • P.P. Gleason et al.

    Medical outcomes and antimicrobial costs with the use of the American Thoracic Society guidelines for outpatients with community-acquired pneumonia

    JAMA

    (1997)
  • M.J. Fine et al.

    The hospital discharge decision for patients with community-acquired pneumonia

    Arch Intern Med

    (1997)
  • M.J. Fine et al.

    The hospital admission decision for patients with community-acquired pneumonia

    Arch Intern Med

    (1997)
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Supported in part by an unrestricted educational grant from PfizerUSPG.

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