A Pathway for Community-Acquired Pneumonia With Rapid Conversion to Oral Therapy Improves Health Care Value. (19th October 2020)

• Record Type: Journal Article
• Authors: Ciarkowski, Claire E; Timbrook, Tristan T; Kukhareva, Polina V; Edholm, Karli M; Hatton, Nathan D; Hopkins, Christy L; Thomas, Frank; Sanford, Matthew N; Igumnova, Elena; Benefield, Russell J; Kawamoto, Kensaku; Spivak, Emily S
• Is Part Of: Open forum infectious diseases. Volume 7:Number 11(2020)
• Publication Date: 2020-10-19
• Subjects: antimicrobial stewardship -- multidisciplinary -- pathway -- pneumonia; Communicable diseases -- Periodicals; Medical microbiology -- Periodicals; Infection -- Periodicals; 616.9
• DOI: 10.1093/ofid/ofaa497
• Languages: English
• ISSNs: 2328-8957

Abstract

Abstract: 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.