Process-of-Care Indicators and Results in Community Acquired Pneumonia after the Introduction of New Guidelines (SEPAR/IDSA)

Abstract

Objective: Process-of-care and outcome indicators obtained with two guidelines for the management of community-acquired pneumonia (CAP) were compared: SEQ/ATS guidelines vs. SEPAR/IDSA guidelines. Patients and methods: Observational prospective study including 457 patients diagnosed for CAP in a hospital general in 2006 (SEQ/ATS guidelines) and 2007 and 2008 (SEPAR/IDSA guidelines). Process-of-care and outcome indicators were compared between the two guidelines and also between the two years after the introduction of the SEPAR/IDSA guidelines. Moreover, the influence of the use of the Pneumonia Severity Index (PSI) was also studied. Results: Global adherence to the guidelines was significantly higher with the SEPAT/IDSA guidelines. Length of hospital stay was not influenced by the adherence to either of the two guidelines. Both guidelines seem to be more useful in ruling serious illness out than in ruling in. The estimation of the severity as measured by the PSI significantly decreased the inappropriate hospitalization of the patients of risk class I-III. In patients of moderate-high risk classes, the adequateness of treatment was higher when the PSI had been estimated in the emergency unit. In the second year of the implementation of SEPAR/IDSA guidelines, mortality was lower and early treatment was higher in the patients of risk classes IV-V in which the PSI had been estimated in the emergency unit, in comparison to the patients in which the PSI had not been estimated. Conclusion: The implementation of the SEPAR/IDSA guidelines improved the process-of-care and outcome indicators of patients diagnosed for CAP.