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A Statewide Collaborative Quality Initiative To Improve Antibiotic Duration And Outcomes Of Patients Hospitalized With Uncomplicated Community-Acquired Pneumonia.
Vaughn VM, Gandhi TN, Hofer TP, Petty LA, Malani AN, Osterholzer D, Dumkow LE, Ratz D, Horowitz JK, McLaughlin ES, Czilok T, Flanders SA. A Statewide Collaborative Quality Initiative To Improve Antibiotic Duration And Outcomes Of Patients Hospitalized With Uncomplicated Community-Acquired Pneumonia. Clinical infectious diseases : an official publication of the Infectious Diseases Society of America. 2021 Nov 13.
Community-acquired pneumonia (CAP) is a common cause for hospitalization and antibiotic overuse. We aimed to improve antibiotic duration for CAP across 41 hospitals participating in the Michigan Hospital Medicine Safety Consortium (HMS).
Prospective collaborative quality initiative including patients hospitalized with uncomplicated CAP who qualified for 5-day antibiotic duration. Between 2/23/2017 and 2/5/2020, HMS targeted appropriate 5-day antibiotic treatment through benchmarking, sharing best practices, and pay-for-performance. Change in outcomes, including appropriate receipt of a 5 (±1) day antibiotic duration and 30-day post discharge composite adverse events (i.e., mortality, readmission, urgent visit, antibiotic-associated adverse events), were assessed over time (per 3-month quarter) using logistic regression controlling for hospital clustering.
41 hospitals and 6,553 patients were included. The percentage of patients treated with an appropriate 5±1 day duration increased from 22.1% (predicted probability 20.9%, 95% CI: 17.2%, 25.0%) to 45.9% (predicted probability 43.9%, 95% CI: 36.8%, 51.2%; adjusted odds ratio [aOR] 1.10 per quarter, 95% CI: 1.07-1.14). 30-day composite adverse events occurred in 18.5% (1,166 /6,319) of patients and decreased over time (aOR 0.98 per quarter, 95% CI: 0.96-0.99) due to a decrease in antibiotic-associated adverse events (aOR 0.91 per quarter, 95% CI: 0.87-0.95).
Across diverse hospitals, HMS participation was associated with more appropriate use of short-course therapy and lower adverse events in hospitalized patients with uncomplicated CAP. Establishment of national or regional CQIs with data collection and benchmarking, sharing of best practices, and pay-for-performance may improve antibiotic use and outcomes for patients hospitalized with uncomplicated CAP.