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(Chest. 1998;114:115-119.)
© 1998 American College of Chest Physicians

A Prospective, Multicenter Study of a Pneumonia Practice Guideline

David C. Rhew MD1; Mary S. Riedinger RN, MSN1; Meenu Sandhu MS1; Constance Bowers RN1; Nancy Greengold MD1; and Scott R. Weingarten MD, MPH1

1 From the Department of Health Services Research, Department of Medicine Cedars-Sinai Health System, UCLA School of Medicine, Los Angeles

Objective: To study the effect of a length of stay practice guideline on patient outcomes.

Design: A prospective, nonrandomized, interventional trial.

Setting: Six geographically distributed hospitals.

Patients: Two hundred forty-two consecutively hospitalized "low-risk" patients with pneumonia.

Measurements and results: One hundred fifty-two patients (63%) completed the mailed postdischarge survey and were included in the analysis. Data were prospectively collected for 85 patients from the baseline observation period (B) and 67 patients from the intervention period (I). During the I, case managers provided physicians with patient risk information based on guideline recommendations. There was no significant change in guideline compliance (B vs I: 76.5% vs 83.6%; p=0.32) or length of stay (B vs I: 3.5 days [95% confidence interval, 3.2 to 3.8] vs 3.6 days [95% confidence interval, 3.3 to 4.0]). Also, there were no statistically significant effects of the intervention on patient outcomes, care following hospital discharge, and patient satisfaction scores.

Conclusion: Patients in this study often had shorter lengths of stay than recommended by the practice guideline. This suggests that the external environment may have had a greater effect on physician behavior and length of stay than the practice guideline itself. Moreover, it demonstrates the importance of continuous assessment of physician practices immediately prior to, during, and after application of the clinical practice guideline.

Key Words: community-acquired pneumonia • health services research • low risk • multicenter • practice guidelines • prospective

Submitted on July 7, 1997
Accepted on December 8, 1997




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