BACKGROUND AND OBJECTIVE: Clinical practice guidelines (CPGs) assist clinicians in making appropriate diagnostic and treatment decisions based on available evidence. The objective of this study was to describe the availability and content of institutional community-acquired pneumonia (CAP) CPGs, and to evaluate the association between institutional CPGs and care utilization, antibiotic administration, and outcomes among children hospitalized with CAP. METHODS: This multicenter retrospective cohort study included children aged 1 to 18 years hospitalized with CAP from July 1, 2009, to June 30, 2011. CPGs from each institution were reviewed to abstract information regarding diagnostic testing and antimicrobial selection. We compared overall and specific utilization patterns, antimicrobial use, and hospital length of stay (LOS) for children with CAP between hospitals with and without CPGs. RESULTS: Thirteen (31.7%) of 41 hospitals had an institutional CPG for nonsevere CAP. There was marked heterogeneity among CPGs. Among the 19,710 children hospitalized with CAP, cost of care, hospital LOS, and 14-day readmission rate were not associated with the presence of a CPG. CPGs did not influence ordering patterns for most diagnostic tests, including blood culture and chest radiographs. Penicillin or aminopenicillins were prescribed to 46.3% of children at institutions where a CPG recommended the use of these antibiotics as first-line agents compared with 23.9% of children at institutions without a CPG (odds ratio = 2.7; 95% confidence interval = 1.4-5.5). CONCLUSIONS: The availability of a CAP CPG had minimal impact on resource utilization and was not associated with cost or hospital LOS. Institutional CPGs, however, did influence patterns of antimicrobial use.
BACKGROUND AND OBJECTIVE: Clinical practice guidelines (CPGs) assist clinicians in making appropriate diagnostic and treatment decisions based on available evidence. The objective of this study was to describe the availability and content of institutional community-acquired pneumonia (CAP) CPGs, and to evaluate the association between institutional CPGs and care utilization, antibiotic administration, and outcomes among children hospitalized with CAP. METHODS: This multicenter retrospective cohort study included children aged 1 to 18 years hospitalized with CAP from July 1, 2009, to June 30, 2011. CPGs from each institution were reviewed to abstract information regarding diagnostic testing and antimicrobial selection. We compared overall and specific utilization patterns, antimicrobial use, and hospital length of stay (LOS) for children with CAP between hospitals with and without CPGs. RESULTS: Thirteen (31.7%) of 41 hospitals had an institutional CPG for nonsevere CAP. There was marked heterogeneity among CPGs. Among the 19,710 children hospitalized with CAP, cost of care, hospital LOS, and 14-day readmission rate were not associated with the presence of a CPG. CPGs did not influence ordering patterns for most diagnostic tests, including blood culture and chest radiographs. Penicillin or aminopenicillins were prescribed to 46.3% of children at institutions where a CPG recommended the use of these antibiotics as first-line agents compared with 23.9% of children at institutions without a CPG (odds ratio = 2.7; 95% confidence interval = 1.4-5.5). CONCLUSIONS: The availability of a CAP CPG had minimal impact on resource utilization and was not associated with cost or hospital LOS. Institutional CPGs, however, did influence patterns of antimicrobial use.
Authors: Naomi S Bardach; Eric Vittinghoff; Renée Asteria-Peñaloza; Jeffrey D Edwards; Jinoos Yazdany; Henry C Lee; W John Boscardin; Michael D Cabana; R Adams Dudley Journal: Pediatrics Date: 2013-08-26 Impact factor: 7.124
Authors: Derek J Williams; Matthew Hall; Jeffrey S Gerber; Mark I Neuman; Adam L Hersh; Thomas V Brogan; Kavita Parikh; Sanjay Mahant; Anne J Blaschke; Samir S Shah; Carlos G Grijalva Journal: Pediatrics Date: 2017-03-08 Impact factor: 7.124
Authors: Derek J Williams; Kathryn M Edwards; Wesley H Self; Yuwei Zhu; Krow Ampofo; Andrew T Pavia; Adam L Hersh; Sandra R Arnold; Jonathan A McCullers; Lauri A Hicks; Anna M Bramley; Seema Jain; Carlos G Grijalva Journal: Pediatrics Date: 2015-07 Impact factor: 7.124
Authors: Amy Tyler; Lisa McLeod; Brenda Beaty; Elizabeth Juarez-Colunga; Meghan Birkholz; Daniel Hyman; Allison Kempe; James Todd; Amanda F Dempsey Journal: Pediatrics Date: 2017-03-14 Impact factor: 7.124
Authors: Derek J Williams; Matthew Hall; Samir S Shah; Kavita Parikh; Amy Tyler; Mark I Neuman; Adam L Hersh; Thomas V Brogan; Anne J Blaschke; Carlos G Grijalva Journal: Pediatrics Date: 2013-10-28 Impact factor: 7.124
Authors: Kavita Parikh; Matt Hall; Anne J Blaschke; Carlos G Grijalva; Thomas V Brogan; Mark I Neuman; Derek J Williams; Jeffrey S Gerber; Adam L Hersh; Samir S Shah Journal: J Hosp Med Date: 2016-01-13 Impact factor: 2.960
Authors: Russell J McCulloh; Michael P Koster; Dwight E Yin; Tiffany L Milner; Shawn L Ralston; Vanessa L Hill; Brian K Alverson; Eric A Biondi Journal: PLoS One Date: 2015-02-06 Impact factor: 3.240