Decreased mortality after implementation of a treatment guideline for community-acquired pneumonia

PURPOSE: We developed a pneumonia guideline at Intermountain Health Care th at included admission decision support and recommendations for antibiotic t iming and selection, based on the 1993 American Thoracic Society guideline. We hypothesized that guideline implementation would decrease mortality. SUBJECTS AND METHODS: We included all immunocompetent patients >65 years wi th community-acquired pneumonia from 1993 through 1997 in Utah; nursing hom e patients were excluded. We compared 30-day mortality rates among patients before and after the guideline was implemented, as well as among patients treated by physicians who did not participate in the guideline program. RESULTS: We observed 28,661 cases of pneumonia, including 7,719 (27%) that resulted in hospital admission. Thirty-day mortality was 13.4% (1,037 of 7, 719) among admitted patients and 6.3% (1,801 of 28,661) overall. Mortality rates (both overall and among admitted patients) were similar among patient s of physicians affiliated and not affiliated with Intermountain Health Car e before the guideline was implemented. For episodes that resulted in hospi tal admission after guideline implementation, 30-day mortality was 11.0% am ong patients treated by Intermountain Health Care-affiliated physicians com pared with 14.2% for other Utah physicians. Analysis that adjusted by logis tic regression for age, sex, rural versus urban residences, and year confir med that 30-day mortality was lower among admitted patients who were treate d by Intermountain Health Care-affiliated physicians (odds ratio [OR]: 0.69 ; 95% confidence interval [CI]: 0.49 to 0.97; P = 0.04) and was somewhat lo wer among all pneumonia patients (OR: 0.81;95% CI: 0.63 to 1.03; P = 0.08). CONCLUSION: Implementation of a pneumonia practice guideline in the Intermo untain Health Care system was associated with a reduction in 30-day mortali ty among elderly patients with pneumonia. (C) 2001 by Excerpta Medica, Inc.