Pneumonia guidelines save lives, study finds

When health-care providers use a standardized, proven treatment regimen for patients with pneumonia, the result is fewer hospital readmissions and deaths associated with the infection, according to a 10-year study published by researchers at Intermountain Healthcare and HealthInsight.

They looked at nearly 18,000 elderly Utahns treated for pneumonia from 1994 to 2003, comparing outcomes for those who received care based on "best-practice" guidelines that IHC had implemented starting in the mid-1990s to those of patients who received more random care.

The researchers' findings were published this week in Chest, the journal of the American College of Chest Physicians.

"Some deaths from pneumonia are going to happen," said Dr. Nathan Dean, a pulmonary and critical-care physician at LDS Hospital who is an adjunct professor at the University of Utah and who led the study. "But the difference is highly significant."

IHC developed its protocols to help doctors accurately identify patients who might have pneumonia and quickly choose and administer the right antibiotic, regardless of whether the patient is being treated in a hospital, clinic or doctor's office. The guidelines combine local best practice with recommendations from the American Thoracic Society.

Pneumonia is the sixth-leading cause of death from infections and a major cause of hospitalizations, with an annual national price tag of more than $10 billion for treatment.

The protocols center on providing the appropriate antibiotics at the right time, getting the patient up early, having a system to determine who should be in the hospital and preventing blood clots.

The researchers used the Medicare database for Utah, and the data was analyzed by HealthInsight, Utah's independent Medicare quality-improvement organization. The Medicare database is the only comprehensive database that includes almost all of a particular population segment, those over 65. And that age group was relevant because it accounts for two-thirds of all pneumonia cases, Dean said.

The endpoint was death within 30 days, regardless of cause. The researchers looked for pneumonia admissions in the database, then did a risk adjustment using age, gender and other medical conditions like diabetes or cancer. They also considered whether the patient had been hospitalized recently and how many times. After all those factors were taken into account, they arrived at a mortality rate.