Gregory B Seymann1. 1. Division of Hospital Medicine, Department of Medicine, University of California, San Diego, School of Medicine, San Diego, California 92103-8485, USA. gseymann@ucsd.edu
Abstract
BACKGROUND: Community-acquired pneumonia (CAP) is one of 3 initial conditions for which the Joint Commission for Accreditation of Healthcare Organizations and the Centers for Medicare & Medicaid Services have defined quality measures. Eight "core measures" of pneumonia care have been targeted for reporting by U.S. hospitals to facilitate performance monitoring. METHODS: A review of the literature supporting the core measures was performed. RESULTS: Indicators encouraging influenza vaccination and appropriate antibiotic selection had the most robust evidence. Rapid delivery of antibiotics also showed significant reduction in mortality, though the actual timing (4 versus 8 hours) varied between studies. Other measures, such as performance of blood cultures, pneumococcal vaccination, smoking cessation, and oxygenation assessment, demonstrated less obvious clinical benefit. CONCLUSIONS: There is inherent value in setting standards of care for high-impact conditions such as CAP, but these standards should be chosen on the basis of high-quality research. Public reporting of the current measures is problematic, as it implies they represent best practices for CAP despite relatively weak evidence. (c) 2006 Society of Hospital Medicine.
BACKGROUND: Community-acquired pneumonia (CAP) is one of 3 initial conditions for which the Joint Commission for Accreditation of Healthcare Organizations and the Centers for Medicare & Medicaid Services have defined quality measures. Eight "core measures" of pneumonia care have been targeted for reporting by U.S. hospitals to facilitate performance monitoring. METHODS: A review of the literature supporting the core measures was performed. RESULTS: Indicators encouraging influenza vaccination and appropriate antibiotic selection had the most robust evidence. Rapid delivery of antibiotics also showed significant reduction in mortality, though the actual timing (4 versus 8 hours) varied between studies. Other measures, such as performance of blood cultures, pneumococcal vaccination, smoking cessation, and oxygenation assessment, demonstrated less obvious clinical benefit. CONCLUSIONS: There is inherent value in setting standards of care for high-impact conditions such as CAP, but these standards should be chosen on the basis of high-quality research. Public reporting of the current measures is problematic, as it implies they represent best practices for CAP despite relatively weak evidence. (c) 2006 Society of Hospital Medicine.
Authors: David T Huang; Donald M Yealy; Michael R Filbin; Aaron M Brown; Chung-Chou H Chang; Yohei Doi; Michael W Donnino; Jonathan Fine; Michael J Fine; Michelle A Fischer; John M Holst; Peter C Hou; John A Kellum; Feras Khan; Michael C Kurz; Shahram Lotfipour; Frank LoVecchio; Octavia M Peck-Palmer; Francis Pike; Heather Prunty; Robert L Sherwin; Lauren Southerland; Thomas Terndrup; Lisa A Weissfeld; Jonathan Yabes; Derek C Angus Journal: N Engl J Med Date: 2018-05-20 Impact factor: 91.245