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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.

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Abstract:

BACKGROUND: 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). METHODS: 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. RESULTS: 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). CONCLUSIONS: 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.





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