Processes of care and outcomes for community-acquired pneumonia

Jonathan S Lee, Brian A Primack, Maria K Mor, Roslyn A Stone, D Scott Obrosky, Donald M Yealy, Michael J Fine
American Journal of Medicine 2011, 124 (12): 1175.e9-17

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.

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