Quality of health care for patients with acute pneumonia in a medical clinic of the university hospital between 2010 and 2014
DOI:
https://doi.org/10.29193/RMU.36.2.1Keywords:
COMMUNITY ACQUIRED INFECTIONS, PNEUMONIA, PRACTICE GUIDELINES, QUALITY OF HEALTH CAREAbstract
Introduction: the extent to which clinical practice guidelines in the handling of community acquired acute pneumonia are observed is not known in Uruguay.
Objective: to assess the degree of compliance with the clinical guidelines in immunocompetent patients hospitalized with a diagnosis of community-acquired pneumonia in a medical clinic of the University Hospital.
Method: observational, retrospective study. Patronymic and clinical variables, and quality of health care indicators were analysed as per international standards. The degree of compliance with indicators was classified as ideal when compliance was > 90%, intermediate when it was between 60% and 90% and low when it was < 60%. ConsenSur II and IDSA were the reference guidelines used.
Results: 143 patients were included in the study, 6.9 % were female (88/140), with a median age of 57 years old (38-73). The population studied was characterized by Charlson median of 1 (0-3), hospitalization median of 10 (7-14) days and 26.6% (38/143) of patients with acute pneumonia criteria. As to compliance with quality of health care indicators: none of them is ideal, 3 in intermediate level (hemoculture in patients with acute pneumonia, hemoculture prior to antibiotic therapy and administration of antibiotics within the first 8 hours), while 4 variables that assess the use of the appropriate antibiotic according to the guidelines and the prevention of pneumonia evidence a low level of compliance.
Conclusions: none of the assessed indicators evidenced an ideal level of compliance. Interventions are required to improve quality in health care for patients with pneumonia.
References
(1) Mandell L, Wunderink R, Anzueto A, Bartlett J, Campbell G, Dean N, et al. Infectious Diseases Society of America/ American Thoracic Society consensus guidelines on the management of community-acquired pneumonia in adults. Clin Infect Dis 2007; 44(Suppl 2):S27-72. doi: 10.1086/511159.
(2) Bantar C, Curcio D, Jasovich A, Bagnulo H, Arango Á, Bavestrello L, et al. Neumonía aguda adquirida en la comunidad en adultos: actualización de los lineamientos para el tratamiento antimicrobiano inicial basado en la evidencia local del grupo de Trabajo de Sudamérica (ConsenSur II). Rev Chil Infectol 2010; 27(Sup 1):9-38.
(3) García L, Grill F, Griot S, Gruss A, Rivero F. Guías prácticas 2017 del hospital maciel para neumonia aguda comunitaria en el adulto. Montevideo: Hospital Maciel, 2017. Disponible en: http://clinicamedica1.com.uy/wp-content/uploads/2017/11/GUIA-NAC-Hospital-Maciel.pdf. [Consulta: 2019].
(4) Programa de Optimización de Antimicrobianos (PROA). Flujograma Neumonía Aguda Comunitaria: criterios internación y gravedad. Montevideo: Hospital de Clínicas, 2018. Disponible en: https://www.proa.hc.edu.uy/images/Flujograma-Neumonia_Aguda.pdf. [Consulta: 2019].
(5) Donabedian A. The quality of care. How can it be assessed? JAMA 1988; 260(12):1743-8. doi: 10.1001/jama.260.12.1743
(6) Trivedi A, Nsa W, Hausmann L, Lee J, Ma A, Bratzler D, et al. Quality and equity of care in U.S. hospitals. N Engl J Med 2014; 371(24):2298-308. doi: 10.1056/NEJMsa1405003
(7) Seymann G. Community-acquired pneumonia: defining quality care. J Hosp Med 2006; 1(6):344-53.
(8) Ramirez J. International CAPO Study protocol: an international, observational study to evaluate current management of hospitalized patients with community-acquired pneumonia. CAPO Version 2017.1. Disponible en: http://www.caposite.com/data/protocols/capo_protocol_current.pdf. [Consulta: 2019].
(9) Ramírez J. Worldwide perspective of the quality of care provided to hospitalized patients with community-acquired pneumonia: results from the CAPO international cohort study. Semin Respir Crit Care Med 2005; 26(6):543-52.
(10) Lim W, van der Eerden M, Laing R, Boersma W, Karalus N, Town G, et al. Defining community acquired pneumonia severity on presentation to hospital: an international derivation and validation study. Thorax 2003; 58(5):377-82.
(11) Levy G, Pérez M, Rodríguez B, Hernández Voth A, Pérez J, Gnoni M, et al. Cumplimiento con las guías nacionales en pacientes hospitalizados con neumonía adquirida en la comunidad: resultados del Estudio Capo en Venezuela. Arch Bronconeumol 2015; 51(4):163–8.
(12) Uruguay. Ministerio de Salud Pública. Campaña de vacunación antigripal y antineumocócica 2017. Montevideo: MSP, 2017. Disponible en: https://www.gub.uy/ministerio-salud-publica/comunicacion/comunicados/campana-de-vacunacion-antigripal-y-antineumococica-2017. [Consulta: 2019].
(13) Christensen D, Luna C, Martinez J, Rodriguez E, Marzoratti L, Gonzalez J, et al. Cumplimiento con las guias nacionales en pacientes hospitalizados con neumonia adquirida en la comunidad: resultados del estudio CAPO en Argentina. Med (Buenos Aires) 2007; 67:709-13.
(14) Luna C, Calmaggi A, Caberloto O, Gentile J, Valentini R, Ciruzzi J, et al. Neumonia Adquirida En La Comunidad. Medicina (B Aires) 2003; 63:319-43.
(15) Gur L, López Strauss A, Rodríguez B, Pérez Mirabal M. Neumonía adquirida en la comunidad (NAC). En: III Reunión de Consenso en Prevención, diagnóstico y tratamiento de las infecciones respiratorias. Caracas: Sociedad Venezolana de Tisiología, Neumonología y Cirugía Torácica, 2009:7-16.
(16) Houck P, Bratzler D, Nsa W, Ma A, Bartlett J. Timing of antibiotic administration and outcomes for Medicare patients hospitalized with community-acquired pneumonia. Arch Intern Med 2004; 164(6):637-44.
(17) Battleman D, Callahan M, Thaler H. Rapid antibiotic delivery and appropriate antibiotic selection reduce length of hospital stay of patients with community-acquired pneumonia: link between quality of care and resource utilization. Arch Intern Med 2002; 162(6):682-8.
(18) Dedier J, Singer D, Chang Y, Moore M, Atlas S. Processes of care, illness severity, and outcomes in the management of community-acquired pneumonia at academic hospitals. Arch Intern Med 2001; 161(17):2099-104.
(19) Marti C, John G, Genné D, Prendki V, Rutschmann O, Stirnemann J, et al. Time to antibiotics administration and outcome in community-acquired pneumonia: secondary analysis of a randomized controlled trial. Eur J Intern Med 2017; 43:58-61. doi: 10.1016/j.ejim.2017.06.012
(20) Arnold F, LaJoie A, Brock G, Peyrani P, Rello J, Menéndez R, et al. Improving outcomes in elderly patients with community-acquired pneumonia by adhering to national guidelines: Community-Acquired Pneumonia Organization International cohort study results. Arch Intern Med 2009; 169(16):1515-24. doi: 10.1001/archinternmed.2009.265
(21) Marrie T, WuL. Factors influencing in-hospital mortality in community-acquired pneumonia: a prospective study of patients not initially admitted to the ICU. Chest 2005; 127(4):1260-70. doi: 10.1378/chest.127.4.1260
(22) Arnold F, Brock G, Peyrani P, Rodríguez E, Díaz A, Rossi P, et al. Predictive accuracy of the pneumonia severity index vs CRB-65 for time to clinical stability: results from the Community-Acquired Pneumonia Organization (CAPO) International Cohort Study. Respir Med 2010; 104(11):1736-43.
(23) Waterer G, Wunderink R. The influence of the severity of community-acquired pneumonia on the usefulness of blood cultures. Respir Med 2001; 95(1):78-82.
(24) Hak E, Buskens E, van Essen G, de Bakker D, Grobbee D, Tacken M, et al. Clinical effectiveness of influenza vaccination in persons younger than 65 years with high-risk medical conditions: the PRISMA study. Arch Intern Med 2005; 165(3):274-80. doi: 10.1001/archinte.165.3.274
(25) Nichol K, Nordin J, Mullooly J, Lask R, Fillbrandt K, Iwane M. Influenza vaccination and reduction in hospitalizations for cardiac disease and stroke among the elderly.N Engl J Med 2003; 348(14):1322-32. doi: 10.1056/NEJMoa025028
(26) Voordouw A, Sturkenboom M, Dieleman J, Stijnen T, Smith D, van der Lei J, et al. Annual revaccination against influenza and mortality risk in community-dwelling elderly persons. JAMA 2004; 292(17):2089-95. doi: 10.1001/jama.292.17.2089
(27) Wiemken T, Carrico R, Klein S, Jonsson C, Peyrani P, Kelley R, et al. The effectiveness of the polysaccharide pneumococcal vaccine for the prevention of hospitalizations due to Streptococcus pneumoniae community-acquired pneumonia in the elderly differs between the sexes: results from the Community-Acquired Pneumonia Organization (CAPO) international cohort study. Vaccine 2014; 32(19):2198-203. doi: 10.1016/j.vaccine.2014.02.048.
(28) Nuorti J, Butler J, Farley M, Harrison L, McGeer A, Kolczak M, et al. Cigarette smoking and invasive pneumococcal disease. Active Bacterial Core Surveillance Team. N Engl J Med 2000; 342(10):681-9.
(29) The Tobacco Use and Dependence Clinical Practice Guideline Panel, Staff, and Consortium Representatives. A clinical practice guideline for treating tobacco use and dependence: a US public health service report. JAMA 2000; 283(24):3244-54.
(2) Bantar C, Curcio D, Jasovich A, Bagnulo H, Arango Á, Bavestrello L, et al. Neumonía aguda adquirida en la comunidad en adultos: actualización de los lineamientos para el tratamiento antimicrobiano inicial basado en la evidencia local del grupo de Trabajo de Sudamérica (ConsenSur II). Rev Chil Infectol 2010; 27(Sup 1):9-38.
(3) García L, Grill F, Griot S, Gruss A, Rivero F. Guías prácticas 2017 del hospital maciel para neumonia aguda comunitaria en el adulto. Montevideo: Hospital Maciel, 2017. Disponible en: http://clinicamedica1.com.uy/wp-content/uploads/2017/11/GUIA-NAC-Hospital-Maciel.pdf. [Consulta: 2019].
(4) Programa de Optimización de Antimicrobianos (PROA). Flujograma Neumonía Aguda Comunitaria: criterios internación y gravedad. Montevideo: Hospital de Clínicas, 2018. Disponible en: https://www.proa.hc.edu.uy/images/Flujograma-Neumonia_Aguda.pdf. [Consulta: 2019].
(5) Donabedian A. The quality of care. How can it be assessed? JAMA 1988; 260(12):1743-8. doi: 10.1001/jama.260.12.1743
(6) Trivedi A, Nsa W, Hausmann L, Lee J, Ma A, Bratzler D, et al. Quality and equity of care in U.S. hospitals. N Engl J Med 2014; 371(24):2298-308. doi: 10.1056/NEJMsa1405003
(7) Seymann G. Community-acquired pneumonia: defining quality care. J Hosp Med 2006; 1(6):344-53.
(8) Ramirez J. International CAPO Study protocol: an international, observational study to evaluate current management of hospitalized patients with community-acquired pneumonia. CAPO Version 2017.1. Disponible en: http://www.caposite.com/data/protocols/capo_protocol_current.pdf. [Consulta: 2019].
(9) Ramírez J. Worldwide perspective of the quality of care provided to hospitalized patients with community-acquired pneumonia: results from the CAPO international cohort study. Semin Respir Crit Care Med 2005; 26(6):543-52.
(10) Lim W, van der Eerden M, Laing R, Boersma W, Karalus N, Town G, et al. Defining community acquired pneumonia severity on presentation to hospital: an international derivation and validation study. Thorax 2003; 58(5):377-82.
(11) Levy G, Pérez M, Rodríguez B, Hernández Voth A, Pérez J, Gnoni M, et al. Cumplimiento con las guías nacionales en pacientes hospitalizados con neumonía adquirida en la comunidad: resultados del Estudio Capo en Venezuela. Arch Bronconeumol 2015; 51(4):163–8.
(12) Uruguay. Ministerio de Salud Pública. Campaña de vacunación antigripal y antineumocócica 2017. Montevideo: MSP, 2017. Disponible en: https://www.gub.uy/ministerio-salud-publica/comunicacion/comunicados/campana-de-vacunacion-antigripal-y-antineumococica-2017. [Consulta: 2019].
(13) Christensen D, Luna C, Martinez J, Rodriguez E, Marzoratti L, Gonzalez J, et al. Cumplimiento con las guias nacionales en pacientes hospitalizados con neumonia adquirida en la comunidad: resultados del estudio CAPO en Argentina. Med (Buenos Aires) 2007; 67:709-13.
(14) Luna C, Calmaggi A, Caberloto O, Gentile J, Valentini R, Ciruzzi J, et al. Neumonia Adquirida En La Comunidad. Medicina (B Aires) 2003; 63:319-43.
(15) Gur L, López Strauss A, Rodríguez B, Pérez Mirabal M. Neumonía adquirida en la comunidad (NAC). En: III Reunión de Consenso en Prevención, diagnóstico y tratamiento de las infecciones respiratorias. Caracas: Sociedad Venezolana de Tisiología, Neumonología y Cirugía Torácica, 2009:7-16.
(16) Houck P, Bratzler D, Nsa W, Ma A, Bartlett J. Timing of antibiotic administration and outcomes for Medicare patients hospitalized with community-acquired pneumonia. Arch Intern Med 2004; 164(6):637-44.
(17) Battleman D, Callahan M, Thaler H. Rapid antibiotic delivery and appropriate antibiotic selection reduce length of hospital stay of patients with community-acquired pneumonia: link between quality of care and resource utilization. Arch Intern Med 2002; 162(6):682-8.
(18) Dedier J, Singer D, Chang Y, Moore M, Atlas S. Processes of care, illness severity, and outcomes in the management of community-acquired pneumonia at academic hospitals. Arch Intern Med 2001; 161(17):2099-104.
(19) Marti C, John G, Genné D, Prendki V, Rutschmann O, Stirnemann J, et al. Time to antibiotics administration and outcome in community-acquired pneumonia: secondary analysis of a randomized controlled trial. Eur J Intern Med 2017; 43:58-61. doi: 10.1016/j.ejim.2017.06.012
(20) Arnold F, LaJoie A, Brock G, Peyrani P, Rello J, Menéndez R, et al. Improving outcomes in elderly patients with community-acquired pneumonia by adhering to national guidelines: Community-Acquired Pneumonia Organization International cohort study results. Arch Intern Med 2009; 169(16):1515-24. doi: 10.1001/archinternmed.2009.265
(21) Marrie T, WuL. Factors influencing in-hospital mortality in community-acquired pneumonia: a prospective study of patients not initially admitted to the ICU. Chest 2005; 127(4):1260-70. doi: 10.1378/chest.127.4.1260
(22) Arnold F, Brock G, Peyrani P, Rodríguez E, Díaz A, Rossi P, et al. Predictive accuracy of the pneumonia severity index vs CRB-65 for time to clinical stability: results from the Community-Acquired Pneumonia Organization (CAPO) International Cohort Study. Respir Med 2010; 104(11):1736-43.
(23) Waterer G, Wunderink R. The influence of the severity of community-acquired pneumonia on the usefulness of blood cultures. Respir Med 2001; 95(1):78-82.
(24) Hak E, Buskens E, van Essen G, de Bakker D, Grobbee D, Tacken M, et al. Clinical effectiveness of influenza vaccination in persons younger than 65 years with high-risk medical conditions: the PRISMA study. Arch Intern Med 2005; 165(3):274-80. doi: 10.1001/archinte.165.3.274
(25) Nichol K, Nordin J, Mullooly J, Lask R, Fillbrandt K, Iwane M. Influenza vaccination and reduction in hospitalizations for cardiac disease and stroke among the elderly.N Engl J Med 2003; 348(14):1322-32. doi: 10.1056/NEJMoa025028
(26) Voordouw A, Sturkenboom M, Dieleman J, Stijnen T, Smith D, van der Lei J, et al. Annual revaccination against influenza and mortality risk in community-dwelling elderly persons. JAMA 2004; 292(17):2089-95. doi: 10.1001/jama.292.17.2089
(27) Wiemken T, Carrico R, Klein S, Jonsson C, Peyrani P, Kelley R, et al. The effectiveness of the polysaccharide pneumococcal vaccine for the prevention of hospitalizations due to Streptococcus pneumoniae community-acquired pneumonia in the elderly differs between the sexes: results from the Community-Acquired Pneumonia Organization (CAPO) international cohort study. Vaccine 2014; 32(19):2198-203. doi: 10.1016/j.vaccine.2014.02.048.
(28) Nuorti J, Butler J, Farley M, Harrison L, McGeer A, Kolczak M, et al. Cigarette smoking and invasive pneumococcal disease. Active Bacterial Core Surveillance Team. N Engl J Med 2000; 342(10):681-9.
(29) The Tobacco Use and Dependence Clinical Practice Guideline Panel, Staff, and Consortium Representatives. A clinical practice guideline for treating tobacco use and dependence: a US public health service report. JAMA 2000; 283(24):3244-54.
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Published
2020-04-30
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Pizzarossa AC, Nicassio L, Cánepa A, Rebella M. Quality of health care for patients with acute pneumonia in a medical clinic of the university hospital between 2010 and 2014. Rev. Méd. Urug. [Internet]. 2020 Apr. 30 [cited 2024 Sep. 16];36(2):121-9. Available from: https://revista.rmu.org.uy/index.php/rmu/article/view/525
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