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RECENT ADVANCES IN CHEST MEDICINE: Michael S. Niederman Recent Advances in Community-Acquired Pneumonia: Inpatient and Outpatient Chest 2007; 131: 1205-1215 [Abstract] [Full text] [PDF]

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Core measures and non-CAP infiltrates

Robert Crausman   (28 April 2007)

Core measures and non-CAP infiltrates 28 April 2007
Robert Crausman, physician Brown Send letter to journal: Re: Core measures and non-CAP infiltrates RSCrausman{at}aol.com Robert Crausman	I would like to thank Dr. Niederman for his outstanding update on CAP. In it he correctly notes the expanding focus upon quality measures to better assess performance of hospitals in caring for patients with CAP. Unfortunately, interest in these core measures has refocused attention on assuring that the measure is met sometimes to the detriment of appropriate clinical diagnosis and treatment. As all Chest physicians, but not all quality reviewers know, all radiographic pulmonary infiltrates are not due to infectious pneumonias. Chemical aspiration and congestive heart failure represent just two of the more common clinical differentials that do not benefit from early treatment with antibiotics. Two that can generally be sorted out during a short period of observation. An unintended consequence of using early antibiotics for CAP as a quality indicator is that some patients are treated needlessly by eager clinicians and clinical pathways in order to achieve high scores on these intermediate measures. As we continue to strive to improve healthcare quality through the use of quality measures we must assure a focus upon cogent measurment. For example, the time from the physician's order for antibiotics to antibiotic administration may be more meaningful than a coarser measure of time from hospital admission to administration. EBM and quality measurement in the context of thoughtful clinical practice is a step forward; improved scores on publically reported univariate measures alone may not be.