Standardized Pneumonia Treatment Guideline Reduces Death Rates

For Release: Monday, April 16, 2001

Contact: Jess Gomez 801-408-2182Note: Embargoed by The American Journal of Medicine

STANDARDIZED TREATMENT GUIDELINE REDUCES DEATH RATES IN PNEUMONIA PATIENTS

SALT LAKE CITY -- A major new study by researchers at Intermountain Health Care and HealthInsight has found that death rates and hospital admissions for patients with community-acquired pneumonia can be significantly reduced by using standardized treatment protocols developed in Utah that help caregivers more quickly and accurately diagnose the illness and begin treatment.

The study is the first of its kind to demonstrate widespread improved clinical outcomes for pneumonia patients through the use of a standardized treatment guideline that was developed to assist caregivers more effectively identify potential pneumonia patients, select appropriate and effective antibiotics, and administer recommended medications, regardless of where the patient is being treated.

Results of the five-year study of more than 29,000 Utah pneumonia patients are published in today's issue of The American Journal of Medicine.

The findings are vital since community-acquired pneumonia continues to be a major health problem in the United States. Not only is it the sixth-leading cause of death and one of the top causes of hospitalizations, it also is costly to treat -- last year consuming more than $8 billion in health care dollars.

"This is an example of best practices medicine where the optimal treatment is identified and then guidelines are developed and implemented across institutional and geographical boundaries so that patients receive the same optimal care regardless of where they are treated, whether it's in a hospital emergency room, a rural clinic, or a primary care physician's office," says Dr. Nathan Dean, a pulmonary medicine specialist at IHC's LDS Hospital, who is principal investigator of the study.

Members of the IHC/HealthInsight research team include: Dr. Dean; Michael P. Silver, MPH; Kim A. Bateman, MD; Brent James, MD; Carol J. Hadlock, BSN, MA; and David Hale, PharmD, MHA.

The research team studied outcomes for all elderly patients in Utah diagnosed with community-acquired pneumonia between 1993 and 1997 and then compared 30-day mortality rates between those who were treated by physicians using the guideline and those that were not. Patients hospitalized after guideline implementation had a 30-day mortality rate of 11 percent, compared with 14.2 percent at control hospitals -- a 30 percent relative reduction in mortality.

The pneumonia treatment guideline was developed at IHC in 1994 after a multi-disciplinary team looking at ways to improve care for pneumonia patients found a wide variation of diagnostic and treatment practices being used throughout the IHC system. At some facilities, nearly 70 different oral and intravenous antibiotics were being used to treat pneumonia patients with no correlation to optimal clinical outcomes.

The guideline was originally initiated in three rural Utah IHC hospitals and clinics in early 1995 and later expanded to other rural hospitals and urban IHC facilities. By the end of 1997, it was implemented in 16 of the 17 IHC hospitals in Utah, including emergency departments and hospital-based clinics, as well as outpatient facilities such as InstaCare clinics.

"Previously, a pneumonia patient could go to one of our hospitals and receive treatment that was very different than he or she would receive at another facility. There was a lot of variation not related to differences in patients," says Dr. Dean. "Now, regardless of whether a pneumonia patient is treated at one of our rural clinics or urban hospitals, they receive the same optimal treatment through the use of the clinical guideline."

Key to the clinical guideline is a standardized initial risk assessment based on age, history, co-existing illnesses, and physical and laboratory abnormalities. Pneumonia patients, with less than two risk factors were recommended for outpatient oral antibiotic treatment. Those with two or more risk factors were evaluated for hospital admission or outpatient treatment with additional therapy.

The practice guideline was developed by combining local practices with American Thoracic Society recommendations. Caregivers reviewed local data, user suggestions, and newly published information on a monthly basis in an effort to gain acceptance among primary care physicians, who deliver the majority of pneumonia care, says Dr. Bateman of HealthInsight.

"A key part of this process was reporting outcome data back to the health care providers who are providing the care so that they could actually see the quality improvements being made with the use of this guideline," says Dr. Bateman.

"Physicians, pharmacists, nurses and administrators throughout IHC deserve the lion's share of credit for this program's successful implementation," says Dr. Dean.

Similar efforts are underway at non-IHC hospitals in Utah and other states. Medicare quality improvement organizations like HealthInsight, are working throughout the United States to similarly improve care of pneumonia patients.

An ancillary study in the American Journal of Medicine published March 1, 2000, demonstrated similar reductions in hospital admissions, hospital lengths of stay, and overall costs through the use of the pneumonia guideline in four IHC urgent care centers. Cost of care was reduced by more than 50 percent, while trends towards improvement in clinical outcomes were observed. The earlier study involved a younger group of mostly outpatients.

"This is further evidence that the guideline is having a positive impact on all of our patients," says Dr. Dean.

IHC is a charitable, community-owned, nonprofit health care organization based in Salt Lake City that serves the health needs of Utah and Idaho residents. The IHC system includes health insurance plans, hospitals, clinics, and affiliated physicians. Last year, in more than 100,000 cases, IHC hospitals and associated clinics provided $31 million in charitable assistance. A central part of IHCs mission is to provide quality medical care to persons with a medical need, regardless of ability to pay.

For over 25 years, HealthInsight has served as a community resource for health care improvement in Utah and Nevada. The company partners with acute care hospitals, physician practices, managed care organizations, health insurance providers, private businesses, and the public sector to improve overall quality of health care.

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