Improving Outcomes From Community-acquired Pneumonia

Grant Watererl Lesley Bennett

Disclosures

Curr Opin Pulm Med. 2015;21(3):219-225. 

In This Article

Abstract and Introduction

Abstract

Purpose of review We are entering into a new era of healthcare wherein patient outcomes are increasingly being publicly reported, not just by institution, but by individual clinicians. This review focuses on the issue of quality of care of patients with community-acquired pneumonia (CAP), in particular the choice of outcome, quality of data needed and recommendations of the current bundle of care suggested by the available literature as delivering the best chance of favourable outcomes for patients.

Recent findings There is increasing evidence that pneumonia outcomes have improved over the past decade, particularly mortality. However, we have been oversimplistic in setting quality targets and that a bundle of care is required to deliver best outcomes, such as has been shown with the surviving sepsis campaign. Equally, the quality of data available to compare outcomes needs to be significantly improved on what is currently available.

Summary To achieve best outcomes for their patients, physicians must be actively comparing their outcomes against other institutions and not rely on historical data. A bundle of care that includes rapid administration of antibiotics, use of combination antibiotic therapy including a macrolide and early mobilization is a good starting point.

Introduction

We are entering a new era of healthcare that many physicians may find confronting and challenging. Both health payers and health consumers are driving increasing analysis and public reporting of differences in patient outcomes between institutions and even between individual practitioners. Such analysis has been enabled by the enormous amount of healthcare data now in accessible electronic form. In turn, the internet has enabled healthcare consumers much greater access to analysis of healthcare data by a variety of sources, including government agencies, health insurers and healthcare providers themselves.

Community-acquired pneumonia (CAP) remains a major cause of hospital admissions.[1] CAP, unlike for example an exacerbation of chronic airways disease, has a gold standard for diagnosis based on radiology and we have a large number of validated methods for predicting patient outcomes on the basis of comorbidities and clinical presentation. It is therefore not surprising that CAP is the respiratory condition that has probably most been targeted for performance measures and comparative outcome analysis.

Although it is understandable that physicians may be concerned about a comparative analysis of patients' outcomes, especially when it is dissected down to individual specialist level, our view is that this is something that should be embraced. In CAP in particular, there is good evidence that some patient outcomes such as mortality and length of stay have improved over the past few decades, at least in some centres.[2,3–5,6] To deliver the highest quality of care to their patients, physicians need to know what the best outcomes are that are currently being achieved and how their own outcomes compare. Equally, as there is evidence that there are differences in patients' outcomes not explained by current measures of severity of CAP,[7] analysing the differences in medical care between sites and how they influence outcome is a key avenue for research.

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