A clinical pathway for community-acquired pneumonia: an observational cohort study
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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.
Christopher R Frei, Allison M. Bell, Kristi A. Traugott, Terry C. Jaso, Kelly R. Daniels, Christine U. Oranasionwu, and Andres D. Ruiz are with the College of Pharmacy, The University of Texas at Austin, 1 University Station A1900, Austin TX, 78712, USA -- Christopher R. Frei, Allison M. Bell, Kristi A. Traugott, Kelly R. Daniels, Christine U. Oramasionwu, and Andres D. Ruiz are with the Pharmacotherapy Education and Research Center, School of Medicine, The University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Drive, Mail Code 6220, San Antonio, TX, 78229-3900, USA -- Kristi A. Traugott is with the Department of Pharmacy, South Texas Veterans Healthcare System, ALMD/UTHSCSA, 7400 Merton Minter Boulevard, San Antonio, TX, 78229, USA -- Terry C. Jaso and William R. Mylchreest are with the Seton Family of Hospitals, P.O. Box 201233, Austin, TX, 78720-1233, USA -- Kelly R. Daniels and Andres D. Ruiz are with the Oakdell Pharmacy, Inc., 7220 Louis Pasteur Drive, Suite 176, San Antonio, TX, 78229, USA -- Eric M. Mortensen and Marcos I. Restrepo are with the Department of Medicine, The University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Drive, San Antonio, TX, 78229-3900, USA -- Marcos I. Restrpo is with VERDICT, South Texas Veterans Healthcare System, ALMD/UTHSCSA, Ambulatory Care (11C6), 7400 Merton Minter Boulevard, San Antonio, TX, 78229, USA -- Monika R. Raut, Alan Fisher, and Jeff R. Schein are with Ortho-McNeil Janssen Scientific Affairs, LLC, 1000 Route 202, P.O. Box 300, Raritan, NJ, 08869, USA