A Pathway for Community-Acquired Pneumonia With Rapid Conversion to Oral Therapy Improves Health Care Value.
Background
Evidence supports streamlined approaches for inpatients with community-acquired pneumonia (CAP) including early transition to oral antibiotics and shorter therapy. Uptake of these approaches is variable, and the best approaches to local implementation of infection-specific guidelines are unknown. Our objective was to evaluate the impact of a clinical decision support (CDS) tool linked with a clinical pathway on CAP care.


Methods
This is a retrospective, observational pre-post intervention study of inpatients with pneumonia admitted to a single academic medical center. Interventions were introduced in 3 sequential 6-month phases; Phase 1: education alone; Phase 2: education and a CDS-driven CAP pathway coupled with active antimicrobial stewardship and provider feedback; and Phase 3: education and a CDS-driven CAP pathway without active stewardship. The 12 months preceding the intervention were used as a baseline. Primary outcomes were length of intravenous antibiotic therapy and total length of antibiotic therapy. Clinical, process, and cost outcomes were also measured.


Results
The study included 1021 visits. Phase 2 was associated with significantly lower length of intravenous and total antibiotic therapy, higher procalcitonin lab utilization, and a 20% cost reduction compared with baseline. Phase 3 was associated with significantly lower length of intravenous antibiotic therapy and higher procalcitonin lab utilization compared with baseline.


Conclusions
A CDS-driven CAP pathway supplemented by active antimicrobial stewardship review led to the most robust improvements in antibiotic use and decreased costs with similar clinical outcomes.
['Ciarkowski|Claire E|CE|0000-0001-7057-0728', 'Timbrook|Tristan T|TT|0000-0002-4542-6203', 'Kukhareva|Polina V|PV|0000-0002-5576-1486', 'Edholm|Karli M|KM|', 'Hatton|Nathan D|ND|', 'Hopkins|Christy L|CL|', 'Thomas|Frank|F|', 'Sanford|Matthew N|MN|', 'Igumnova|Elena|E|', 'Benefield|Russell J|RJ|', 'Kawamoto|Kensaku|K|', 'Spivak|Emily S|ES|']
pathway pneumonia antimicrobial stewardship multidisciplinary