A clinical pathway for community-acquired pneumonia

An observational cohort study

Christopher R. Frei, Allison M. Bell, Kristi A. Traugott, Terry C. Jaso, Kelly R. Daniels, Eric M. Mortensen, Marcos I. Restrepo, Christine U. Oramasionwu, Andres D. Ruiz, William R. Mylchreest, Vanja Sikirica, Monika R. Raut, Alan Fisher, Jeff R. Schein

Research output: Contribution to journalArticle

8 Citations (Scopus)

Abstract

Background: Six hospitals instituted a voluntary, system-wide, pathway for community acquired pneumonia (CAP). We proposed this study to determine the impact of pathway antibiotics on patient survival, hospital length of stay (LOS), and total hospital cost.Methods: Data were collected for adults from six U.S. hospitals with a principal CAP discharge diagnosis code, a chest infiltrate, and medical notes indicative of CAP from 2005-2007. Pathway and non-pathway cohorts were assigned according to antibiotics received within 48 hours of admission. Pathway antibiotics included levofloxacin 750 mg monotherapy or ceftriaxone 1000 mg plus azithromycin 500 mg daily. Multivariable regression models assessed 90-day mortality, hospital LOS, total hospital cost, and total pharmacy cost.Results: Overall, 792 patients met study criteria. Of these, 505 (64%) received pathway antibiotics and 287 (36%) received non-pathway antibiotics. Adjusted means and p-values were derived from Least Squares regression models that included Pneumonia Severity Index risk class, patient age, heart failure, chronic obstructive pulmonary disease, and admitting hospital as covariates. After adjustment, patients who received pathway antibiotics experienced lower adjusted 90-day mortality (p = 0.02), shorter mean hospital LOS (3.9 vs. 5.0 days, p < 0.01), lower mean hospital costs ($2,485 vs. $3,281, p = 0.02), and similar mean pharmacy costs ($356 vs. $442, p = 0.11).Conclusions: Pathway antibiotics were associated with improved patient survival, hospital LOS, and total hospital cost for patients admitted to the hospital with CAP.

Original languageEnglish (US)
Article number188
JournalBMC Infectious Diseases
Volume11
DOIs
StatePublished - Jul 6 2011

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Critical Pathways
Observational Studies
Length of Stay
Pneumonia
Cohort Studies
Anti-Bacterial Agents
Hospital Costs
Costs and Cost Analysis
Levofloxacin
Azithromycin
Survival
Ceftriaxone
Mortality
Least-Squares Analysis
Chronic Obstructive Pulmonary Disease
Thorax
Heart Failure

ASJC Scopus subject areas

  • Infectious Diseases

Cite this

Frei, C. R., Bell, A. M., Traugott, K. A., Jaso, T. C., Daniels, K. R., Mortensen, E. M., ... Schein, J. R. (2011). A clinical pathway for community-acquired pneumonia: An observational cohort study. BMC Infectious Diseases, 11, [188]. https://doi.org/10.1186/1471-2334-11-188

A clinical pathway for community-acquired pneumonia : An observational cohort study. / Frei, Christopher R.; Bell, Allison M.; Traugott, Kristi A.; Jaso, Terry C.; Daniels, Kelly R.; Mortensen, Eric M.; Restrepo, Marcos I.; Oramasionwu, Christine U.; Ruiz, Andres D.; Mylchreest, William R.; Sikirica, Vanja; Raut, Monika R.; Fisher, Alan; Schein, Jeff R.

In: BMC Infectious Diseases, Vol. 11, 188, 06.07.2011.

Research output: Contribution to journalArticle

Frei, CR, Bell, AM, Traugott, KA, Jaso, TC, Daniels, KR, Mortensen, EM, Restrepo, MI, Oramasionwu, CU, Ruiz, AD, Mylchreest, WR, Sikirica, V, Raut, MR, Fisher, A & Schein, JR 2011, 'A clinical pathway for community-acquired pneumonia: An observational cohort study', BMC Infectious Diseases, vol. 11, 188. https://doi.org/10.1186/1471-2334-11-188
Frei, Christopher R. ; Bell, Allison M. ; Traugott, Kristi A. ; Jaso, Terry C. ; Daniels, Kelly R. ; Mortensen, Eric M. ; Restrepo, Marcos I. ; Oramasionwu, Christine U. ; Ruiz, Andres D. ; Mylchreest, William R. ; Sikirica, Vanja ; Raut, Monika R. ; Fisher, Alan ; Schein, Jeff R. / A clinical pathway for community-acquired pneumonia : An observational cohort study. In: BMC Infectious Diseases. 2011 ; Vol. 11.
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abstract = "Background: Six hospitals instituted a voluntary, system-wide, pathway for community acquired pneumonia (CAP). We proposed this study to determine the impact of pathway antibiotics on patient survival, hospital length of stay (LOS), and total hospital cost.Methods: Data were collected for adults from six U.S. hospitals with a principal CAP discharge diagnosis code, a chest infiltrate, and medical notes indicative of CAP from 2005-2007. Pathway and non-pathway cohorts were assigned according to antibiotics received within 48 hours of admission. Pathway antibiotics included levofloxacin 750 mg monotherapy or ceftriaxone 1000 mg plus azithromycin 500 mg daily. Multivariable regression models assessed 90-day mortality, hospital LOS, total hospital cost, and total pharmacy cost.Results: Overall, 792 patients met study criteria. Of these, 505 (64{\%}) received pathway antibiotics and 287 (36{\%}) received non-pathway antibiotics. Adjusted means and p-values were derived from Least Squares regression models that included Pneumonia Severity Index risk class, patient age, heart failure, chronic obstructive pulmonary disease, and admitting hospital as covariates. After adjustment, patients who received pathway antibiotics experienced lower adjusted 90-day mortality (p = 0.02), shorter mean hospital LOS (3.9 vs. 5.0 days, p < 0.01), lower mean hospital costs ($2,485 vs. $3,281, p = 0.02), and similar mean pharmacy costs ($356 vs. $442, p = 0.11).Conclusions: Pathway antibiotics were associated with improved patient survival, hospital LOS, and total hospital cost for patients admitted to the hospital with CAP.",
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T1 - A clinical pathway for community-acquired pneumonia

T2 - An observational cohort study

AU - Frei, Christopher R.

AU - Bell, Allison M.

AU - Traugott, Kristi A.

AU - Jaso, Terry C.

AU - Daniels, Kelly R.

AU - Mortensen, Eric M.

AU - Restrepo, Marcos I.

AU - Oramasionwu, Christine U.

AU - Ruiz, Andres D.

AU - Mylchreest, William R.

AU - Sikirica, Vanja

AU - Raut, Monika R.

AU - Fisher, Alan

AU - Schein, Jeff R.

PY - 2011/7/6

Y1 - 2011/7/6

N2 - Background: Six hospitals instituted a voluntary, system-wide, pathway for community acquired pneumonia (CAP). We proposed this study to determine the impact of pathway antibiotics on patient survival, hospital length of stay (LOS), and total hospital cost.Methods: Data were collected for adults from six U.S. hospitals with a principal CAP discharge diagnosis code, a chest infiltrate, and medical notes indicative of CAP from 2005-2007. Pathway and non-pathway cohorts were assigned according to antibiotics received within 48 hours of admission. Pathway antibiotics included levofloxacin 750 mg monotherapy or ceftriaxone 1000 mg plus azithromycin 500 mg daily. Multivariable regression models assessed 90-day mortality, hospital LOS, total hospital cost, and total pharmacy cost.Results: Overall, 792 patients met study criteria. Of these, 505 (64%) received pathway antibiotics and 287 (36%) received non-pathway antibiotics. Adjusted means and p-values were derived from Least Squares regression models that included Pneumonia Severity Index risk class, patient age, heart failure, chronic obstructive pulmonary disease, and admitting hospital as covariates. After adjustment, patients who received pathway antibiotics experienced lower adjusted 90-day mortality (p = 0.02), shorter mean hospital LOS (3.9 vs. 5.0 days, p < 0.01), lower mean hospital costs ($2,485 vs. $3,281, p = 0.02), and similar mean pharmacy costs ($356 vs. $442, p = 0.11).Conclusions: Pathway antibiotics were associated with improved patient survival, hospital LOS, and total hospital cost for patients admitted to the hospital with CAP.

AB - Background: Six hospitals instituted a voluntary, system-wide, pathway for community acquired pneumonia (CAP). We proposed this study to determine the impact of pathway antibiotics on patient survival, hospital length of stay (LOS), and total hospital cost.Methods: Data were collected for adults from six U.S. hospitals with a principal CAP discharge diagnosis code, a chest infiltrate, and medical notes indicative of CAP from 2005-2007. Pathway and non-pathway cohorts were assigned according to antibiotics received within 48 hours of admission. Pathway antibiotics included levofloxacin 750 mg monotherapy or ceftriaxone 1000 mg plus azithromycin 500 mg daily. Multivariable regression models assessed 90-day mortality, hospital LOS, total hospital cost, and total pharmacy cost.Results: Overall, 792 patients met study criteria. Of these, 505 (64%) received pathway antibiotics and 287 (36%) received non-pathway antibiotics. Adjusted means and p-values were derived from Least Squares regression models that included Pneumonia Severity Index risk class, patient age, heart failure, chronic obstructive pulmonary disease, and admitting hospital as covariates. After adjustment, patients who received pathway antibiotics experienced lower adjusted 90-day mortality (p = 0.02), shorter mean hospital LOS (3.9 vs. 5.0 days, p < 0.01), lower mean hospital costs ($2,485 vs. $3,281, p = 0.02), and similar mean pharmacy costs ($356 vs. $442, p = 0.11).Conclusions: Pathway antibiotics were associated with improved patient survival, hospital LOS, and total hospital cost for patients admitted to the hospital with CAP.

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DO - 10.1186/1471-2334-11-188

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