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Clinical practice guidelines for CAP had minimal effect on resource use
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The availability of a clinical practice guideline for community-acquired pneumonia had a negligible effect on resource utilization and was not linked to cost or the length of hospital stay. However, institutional clinical practice guidelines influenced patterns of antimicrobial use, according to recent study data.
In previous studies, hospitals with clinical practice guidelines in effect for conditions that included bronchiolitis, urinary tract infections and acute gastroenteritis exhibited shorter length of stay, reduced charges per admission and a reduction of resource utilization than hospitals without similar guidelines.
“Variability exists in a number of aspects of community-acquired pneumonia (CAP) management, including initial laboratory testing and antibiotic prescribing,” Mark I. Neuman, MD, MPH, of the division of emergency medicine at Children’s Hospital Boston, and colleagues wrote. “Care variation contributes to increased costs and disparate outcomes. Clinical practice guidelines can favorably influence utilization and clinical outcomes by developing evidence-based, peer-reviewed recommendations for patient care.”
To assess the relationship between institutional clinical practice guidelines and care utilization, antibiotic administration, and outcomes among children hospitalized with CAP, Neuman and colleagues launched a retrospective cohort study of children aged 1 to 18 years hospitalized with CAP from July 2009 to June 2011.
In the study, researchers sent surveys to the quality officer at each participating hospital to establish whether the institution had a clinical practice guideline for the treatment of children with CAP. Hospitals that responded positively to the questionnaire regarding an institutional clinical practice guideline were asked to share them.
Guidelines from each institution were reviewed for abstract information regarding diagnostic testing and antimicrobial selection. The researchers then compared overall and specific utilization patterns, antimicrobial use and hospital length of stay for children with CAP between hospitals with and without clinical practice guidelines.
According to the study, 13 (31.7%) of 41 hospitals had an institutional clinical practice guideline for nonsevere CAP. Among the 19,710 children hospitalized with CAP, cost of care, hospital length of stay and 14-day readmission rate were not associated with the presence of a clinical practice guideline.
Penicillin or aminopenicillins were prescribed to 46.3% of children at institutions where a clinical practice guideline had recommended the use of these antibiotics as first-line agents compared with 23.9% of children at institutions without a clinical practice guideline (OR=2.7; 95% CI, 1.4-5.5). In addition, guidelines did not influence ordering patterns for most diagnostic tests, such as chest radiographs and blood cultures.
“Although CAP guidelines were not significantly associated with diagnostic testing or clinical outcomes, they were associated with narrow-spectrum antibiotic use,” Neuman and colleagues wrote. “The recent publication of consensus guidelines may help to standardize the approach to the care of the child with pneumonia. Strategies aimed at optimizing the implementation, dissemination, and evaluation of clinical guidelines will be needed to truly impact patient care.”
Disclosure: The researchers reported no relevant financial disclosures.
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