A statewide initiative to improve the care of hospitalized pneumonia patients: The Connecticut pneumonia pathway project

PURPOSE: A statewide quality improvement initiative was conducted in Connec ticut to improve process-of-care performance and to decrease length of stay for patients hospitalized with community-acquired pneumonia. SETTING AND METHODS: Data were collected on 1,242 elderly (greater than or equal to 65 years) pneumonia patients hospitalized at 31 of 32 acute care h ospitals between January 16, 1995, and March 15, 1996, and on 1,146 patient s hospitalized between January 1, 1997, and June 30, 1997. Interventions in cluded feedback of performance data (Qualidigm, the Connecticut Peer Review Organization), dissemination of an evidence-based pneumonia critical pathw ay (Connecticut Thoracic Society), and sharing of pathway implementation ex periences (hospitals). Process and outcome measures included early antibiot ic administration, blood culture collection, oxygenation assessment, length of stay, 30-day mortality, and 30-day readmission rates. Analyses were adj usted for severity of illness and hospital-specific practice patterns. RESULTS: After the statewide initiative, improvements were noted in antibio tic administration within 8 hours of hospital arrival (improvement from 83. 4% to 88.8%, relative risk [RR] = 1.21; 95% confidence interval [CI]: 1.10 to 1.32), oxygenation assessment within 24 hours of hospital arrival (93.6% to 95.4%; RR = 1.23, 95% CI: 1.11 to 1.38), and length of stay (7 days to 5 days, P <0.001). There were no significant changes in blood culture colle ction within 24 hours of hospital arrival, blood culture collection before antibiotic administration, 30-day mortality, or 30-day readmission rates. CONCLUSIONS: statewide improvements were demonstrated in the care of hospit alized pneumonia patients concurrent with a multifaceted quality improvemen t intervention. Further research is needed to separate the effects of the q uality improvement interventions from secular trends. (C) 2001 by Excerpta Medica, Inc.