Processes of Care and Outcomes for Community-Acquired Pneumonia

Abstract

Background Although processes of care are common proxies for health care quality, their associations with medical outcomes remain uncertain. Methods For 2076 patients hospitalized with pneumonia from 32 emergency departments, we used multilevel logistic regression modeling to assess independent associations between patient outcomes and the performance of 4 individual processes of care (assessment of oxygenation, blood cultures, and rapid initiation [<4 hours] and appropriate selection of antibiotic therapy) and the cumulative number of processes of care performed. Results Overall, 141 patients (6.8%) died. Mortality was 0.3% to 1.7% lower for patients who had each of the individual processes of care performed ( P ≥.13 for each comparison); mortality was 7.5% for patients who had 0 to 2 processes of care, 7.2% for those with 3 processes of care, and 5.8% for those with all 4 processes of care performed ( P = .39). Mortality was not significantly associated with either individual or cumulative process measures in multivariable models. Conclusion Neither the individual processes of care nor the cumulative number performed is associated with short-term mortality for pneumonia.