This amended application from the University of Pittsburgh proposes a multi-center, randomized, single-blinded study.
The specific aims are to: 1) determine the effectiveness of a medical practice guideline to reduce hospital length of stay (LOS) for patients with community-acquired pneumonia (CAP) using a dissemination strategy (intervention) implemented through study hospital utilization management (UM) programs, 2) compare the medical costs of care and the outcomes of patients managed by physicians who received the intervention to patients of physicians in the usual medical care group, and 3) evaluate the process of guideline dissemination to determine the factors associated with guideline compliance. The applicants expect that length of stay for patients with community acquired pneumonia can be decreased. Further, they suggest that a medical practice guideline implemented using a carefully constructed dissemination strategy (i.e., a detail sheet, a nurse mediated reminder and concurrent feedback system, and provision of an alternative clinical practice option that uses nurse home visits after discharge, conducted under the auspices of a hospital utilization management program) will achieve shorter lengths of stay more quickly than will reduced length of stay be achieved by medical practices that do not receive the intervention. Thirty days from first guideline eligibility, secondary measures will be acquired. They include: mortality, morbidity, symptoms resolution, functional status, readmission rates, patient satisfaction with care, stability at discharge, medical care costs, and physician compliance with the guideline. The application is theoretically grounded in the PRECEDE model and social influence perspective of physician behavior change. The results of the study should help to reduce unnecessary hospital stays for patients with CAP. The average length of stay is 7.2 days in the targeted geographic region. A reduced length of stay by one day should result in major cost savings. The applicants suggest that hospital-based utilization management programs will continue to be pressured in regard to unnecessarily prolonged lengths of stay. They suggest further that if the study does not lead to decreased lengths of stay, valuable information on the process of guideline dissemination and reasons for guideline failure will improve the understanding of physician behavior change.
| Jasti, Harish; Mortensen, Eric M; Obrosky, David Scott et al. (2008) Causes and risk factors for rehospitalization of patients hospitalized with community-acquired pneumonia. Clin Infect Dis 46:550-6 |
