Do guidelines for community-acquired pneumonia improve the cost-effectiveness of hospital care?

There is growing pressure to demonstrate the value of practice guidelines. We have reviewed the evidence that guidelines for the treatment of communit y-acquired pneumonia (CAP) change current practices and that the standardiz ation of practices reduces costs and/or improves outcome. The most obvious barrier to implementation of the guidelines is lack of knowledge about thei r content; equally important are the attitudes and behavior of professional s, patients, and their caregivers. Guidelines may improve the outcome of CA P, provided that there is an association between variations in outcome and some specific processes of care. Conversely, when there is no such relation ship, guidelines may reduce the cost of care without having an adverse effe ct on outcome. The cost-effectiveness of CAP guidelines in an individual ho spital depends on the systems that are available to identify patients with CAP and to measure the processes of care. There is good evidence that follo wing the recommendations of the CAP guidelines does improve the cost-effect iveness of care and, therefore, that an audit of CAP may be worth the effor t.