Community-acquired pneumonia (CAP) is a common, serious, and costly infection in the VA. Published interventions have focused on the hospital admission and discharge decisions because these are the two most important leverage points for managing risk and controlling resource use for patients with CAP. Despite the existence of evidence-based interventions, a wide variation in both the proportion of low-risk patients that are treated in the ambulatory setting and the length-of-stay among patients hospitalized with CAP remains, suggesting there is an opportunity for improvement.
(1) To package a Web-based toolkit for enhancing implementation of evidence-based interventions to improve the appropriateness of the admission and discharge decisions for patients with CAP; (2) To build a business case model for implementing these interventions within VA; and (3) To create a marketing plan for the toolkit and business case model.
The project team utilized the CDC's Replicating Effective Programs framework to package the toolkits for improving the appropriateness of the admission and discharge decisions. First, the team identified the core elements of effective interventions and developed a menu of options for implementing them at individual VA Medical Centers. Then, project members communicated these core elements in manuals that are designed to be easily understood by health care providers and staff. In addition to assembling the toolkits, project members developed a business case to convince administrators that the costs avoided by successfully putting into practice interventions to reduce the admission of low-risk patients with CAP and the length of stay in clinically stable patients who are hospitalized exceed the implementation costs.
The toolkits developed by the project team contain the following: 1) user's guide; 2) admission or discharge decision calculator; 4) educational slides; 5) poster for marketing purposes; 6) business case, and 7) other materials as applicable. These toolkits are posted on the Office of Quality and Performance website. The business case presents the estimated net savings for individual medical centers, Veterans Integrated Service Networks (VISNs), and the VA nationally. It also includes the underlying assumptions and the effect of varying key assumptions on the net savings. For the admission decision, over 7 million dollars could be saved nationally if specified medical centers implemented an intervention strategy to improve the initial site of treatment decision. For the discharge decision, the estimated net savings nationally is over 9 million dollars.
Use of these toolkits is likely to lead to considerable improvements in the efficiency of care for patients with pneumonia by safely increasing the proportion of low-risk patients who are treated as outpatients and the proportion of inpatients that are discharged upon reaching clinical stability. Based on the results of the business case, over 16 million dollars could be saved by the VA nationally in one year.
- Rodriguez KL, Burkitt KH, Sevick MA, Obrosky DS, Aspinall SL, Switzer G, Mor MK, Fine MJ. Assessing processes of care to promote timely initiation of antibiotic therapy for emergency department patients hospitalized for pneumonia. Joint Commission Journal on Quality and Patient Safety. 2009 Oct 1; 35(10):509-18.