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Quality and Affecting Factor of Care for Patients Hospitalized with Pneumonia

Tuberculosis & Respiratory Diseases / Tuberculosis & Respiratory Diseases,
2009, v.66 no.4, pp.300-308







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Abstract

Background: The quality of care for patients with community acquired pneumonia needs to be improved; the factors affecting this care need to be analyzed. The objectives of this study were used to measure the performance of care processes of for patients with pneumonia and to determine those patient and hospital characteristics are associated with quality care. Methods: The analysis was performed using data from 21 hospitals that had over 500 beds for 1,001 patients, who were sampled randomly. All patients were born before 31 December 1989, and discharged between the two months’ August 2006 and October 2006. Performance process indicators were measured by respective hospital, and multivariate logistic regression was used to calculate associations between patients and hospital characteristics using 4 process indicators. Results: Performance rates in timely assessment of oxygenation assessments and blood cultures, correct administration of antibiotic medications, and blood culture performed prior to initial antibiotics were 69.4%, 79.1%, 82.5% and 60.5%, respectively. Age had a positive affect on oxygenation assessment within 24 hours. Bed number, number of nurses per bed, annual number of emergency department visits, average percentage of beds filled, location and arrival time, and site were factors associated with process indicators. Conclusion: It is necessary to make up for the weak points in the process of care for patients with community acquired pneumonia, by enforcing quality assurance. To reduce performance rate variation among hospitals, improvement in care protocols is required for hospitals that have poor quality of care levels.

keywords
Pneumonia, Health care quality indicators, Process assessment, Logistic models

Reference

1.

Korea National Statistical Office. Annual report on the cause of death statistics. Daejeon: Korea National Statistical Office; 2008. Available from: http://www.kosis.kr.

2.

National Health Insurance Corporation, Health Insurance Review & Assessment Service. National health insurance statistical yearbook, 2006. Seoul: National Health Insurance Corporation, Health Insurance Review & Assessment Service; 2007.

3.

Colice GL, Morley MA, Asche C, Birnbaum HG. Treatment costs of community-acquired pneumonia in an employed population. Chest 2004;125:2140-5.

4.

Meehan TP, Fine MJ, Krumholz HM, Scinto JD, Galusha DH, Mockalis JT, et al. Quality of care, process, and outcomes in elderly patients with pneumonia. JAMA 1997;278:2080-4.

5.

Bratzler DW, Nsa W, Houck PM. Performance measures for pneumonia: are they valuable, and are process measure adequate? Curr Opin Infect Dis 2007;20:182-9.

6.

Fine JM, Fine MJ, Galusha D, Petrillo M, Meehan TP. Patient and hospital characteristics associated with recommended processes of care for elderly patients hospitalized with pneumonia: results from the medicare quality indicator system pneumonia module. Arch Intern Med 2002;162:827-33.

7.

Mitchiner JC, Hutto SL. The effect of selected hospital characteristics on the timeliness of antibiotic administration for pneumonia. Am J Med Qual 2007;22:259-64.

8.

Dedier J, Singer DE, Chang Y, Moore M, Atlas SJ. Process of care, illness severity, and outcomes in the management of community-acquired pneumonia at academic hospitals. Arch Intern Med 2001;161:2099-104.

9.

Ministry for Health and Welfare, Seoul National University College of Medicine. Analyzing the results of model interpretation of clinical quality indicator. Seoul: Ministry for Health and Welfare; 2007.

10.

Fine MJ, Auble TE, Yealy DM, Hanusa BH, Weissfeld LA, Singer DE, et al. A prediction rule to identify lowrisk patients with community-acquired pneumonia. N Engl J Med 1997;336:243-50.

11.

Meehan TP, Weingarten SR, Holmboe ES, Mathur D, Wang Y, Petrillo MK, et al. A statewide initiative to improve the care of hospitalized pneumonia patients: The Connecticut Pneumonia Pathway Project. Am J Med 2001;111:203-10.

12.

Mandell LA, Wunderink RG, Anzueto A, Bartlett JG, Campbell GD, Dean NC, et al. Infectious Diseases Society of America/American Thoracic Society consensus guidelines on the management of communityacquired pneumonia in adults. Clin Infect Dis 2007;44 Suppl 2:S27-72.

13.

The Korean Academy of Tuberculosis and Respiratory Diseases. [Guidelines on the management of community- acquired pneumonia in adults]. Seoul: The Korean Academy of Tuberculosis and Respiratory Diseases; 2007. Available from: http://www.lungkorea.com/thesis/guide.php.

14.

Houck PM, Bratzler DW, Nsa W, Ma A, Bartlett JG. Timing of antibiotic administration and outcomes for Medicare patients hospitalized with community-acquired pneumonia. Arch Intern Med 2004;164:637-44.

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