Implementation of an evidence-based guideline to reduce duration of intravenous antibiotic therapy and length of stay for patients hospitalized with community-acquired pneumonia: A randomized controlled trial

被引:73
|
作者
Fine, MJ
Stone, RA
Lave, JR
Hough, LJ
Obrosky, DS
Mor, MK
Kapoor, WN
机构
[1] Univ Pittsburgh, Grad Sch Publ Hlth, Div Gen Med, Pittsburgh, PA USA
[2] Univ Pittsburgh, Grad Sch Publ Hlth, Dept Med, Pittsburgh, PA USA
[3] Univ Pittsburgh, Grad Sch Publ Hlth, Dept Hlth Policy, Pittsburgh, PA USA
[4] Univ Pittsburgh, Grad Sch Publ Hlth, Dept Hlth Policy & Management, Pittsburgh, PA USA
[5] Univ Pittsburgh, Grad Sch Publ Hlth, Dept Biostat, Pittsburgh, PA USA
[6] Univ Pittsburgh, Ctr Res Hlth Care, Div Gen Med, Pittsburgh, PA USA
[7] Univ Pittsburgh, Ctr Res Hlth Care, Dept Med, Pittsburgh, PA USA
[8] Univ Pittsburgh, Ctr Res Hlth Care, Dept Hlth Policy & Management, Pittsburgh, PA USA
[9] Univ Pittsburgh, Ctr Res Hlth Care, Dept Biostat, Pittsburgh, PA USA
[10] VA Ctr Hlth Equity Res & Promot, Pittsburgh, PA USA
[11] VA Pittsburgh Healthcare Syst, Pittsburgh, PA USA
来源
AMERICAN JOURNAL OF MEDICINE | 2003年 / 115卷 / 05期
关键词
D O I
10.1016/S0002-9343(03)00395-4
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
PURPOSE: Patients with pneumonia often remain hospitalized after they are stable clinically, and the duration of intravenous antibiotic therapy is a rate-limiting step for discharge. The purpose of this study was to determine whether implementation of an evidence-based guideline would reduce the duration of intravenous antibiotic therapy and length of stay for patients hospitalized with pneumonia. METHODS: In a seven-site, cluster randomized clinical trial, we enrolled 325 control and 283 intervention patients who were admitted by one of 116 physician groups. Within site, physician groups were assigned randomly to receive a practice guideline alone (control arm) or a practice guideline that was implemented using a multifaceted strategy (intervention arm). The effectiveness of guideline implementation was measured by the duration of intravenous antibiotic therapy and length of stay; differences in the rates of discontinuation and hospital discharge were assessed with proportional hazards models. Medical outcomes were assessed at 30 days. RESULTS: Intravenous antibiotic therapy was discontinued somewhat more quickly in the intervention group (hazard ratio [HR] = 1.23; 95% confidence interval [Cl]: 1.00 to 1.52; P = 0.06) than in the control group. Intervention patients were discharged more quickly, but the difference was not statistically significant (FIR = 1.16; 95% Cl: 0.97 to 1.38; P = 0.11). Fewer intervention (55% [157/283]) than control (63% [206/325]) patients had medical complications during the index hospitalization (P = 0.04), with no differences in other medical outcomes, including mortality, rehospitalization, and return to usual activities, between treatment arms. CONCLUSION: The multifaceted guideline implementation strategy resulted in a slight reduction in the duration of intravenous antibiotic therapy and a nonsignificant reduction in length of stay, without affecting patient outcomes. (C) 2003 by Excerpta Medica Inc.
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页码:343 / 351
页数:9
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