Processes of care and outcomes for community-acquired pneumonia.

Lee JS, Primack BA, Mor MK, Stone RA, Obrosky DS, Yealy DM, Fine MJ. Processes of care and outcomes for community-acquired pneumonia. The American journal of medicine. 2011 Dec 1; 124(12):1175.e9-17.

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Abstract:

BACKGROUND: Although processes of care are common proxies for health care quality, their associations with medical outcomes remain uncertain. METHODS: For 2076 patients hospitalized with pneumonia from 32 emergency departments, we used multilevel logistic regression modeling to assess independent associations between patient outcomes and the performance of 4 individual processes of care (assessment of oxygenation, blood cultures, and rapid initiation [ < 4 hours] and appropriate selection of antibiotic therapy) and the cumulative number of processes of care performed. RESULTS: Overall, 141 patients (6.8%) died. Mortality was 0.3% to 1.7% lower for patients who had each of the individual processes of care performed (P = .13 for each comparison); mortality was 7.5% for patients who had 0 to 2 processes of care, 7.2% for those with 3 processes of care, and 5.8% for those with all 4 processes of care performed (P = .39). Mortality was not significantly associated with either individual or cumulative process measures in multivariable models. CONCLUSION: Neither the individual processes of care nor the cumulative number performed is associated with short-term mortality for pneumonia.