Author | Moreira, Rodrigo C. | |
Author | Mendonca-Filho, Hugo T. | |
Author | Farias, Ayla M. | |
Author | Sznejder, Henry | |
Author | Lang, Eddy | |
Author | Wilson, Margaret M. | |
Access date | 2020-12-15T11:45:13Z | |
Available date | 2020-12-15T11:45:13Z | |
Document date | 2020 | |
Citation | MOREIRA, Rodrigo C. et al. Development and Implementation of a Clinical Pathway to Reduce Inappropriate Admissions Among Patients with Community-Acquired Pneumonia in a Private Health System in Brazil: An Observational Cohort Study and a Promising Tool for Efficiency Improvement. Open Access Emergency Medicine, v. 12, p. 181-191, 2020. | pt_BR |
ISSN | 1179-1500 | pt_BR |
URI | https://www.arca.fiocruz.br/handle/icict/44881 | |
Language | eng | pt_BR |
Publisher | Dove Medical Press | pt_BR |
Rights | open access | pt_BR |
Title | Development and Implementation of a Clinical Pathway to Reduce Inappropriate Admissions Among Patients with Community-Acquired Pneumonia in a Private Health System in Brazil: An Observational Cohort Study and a Promising Tool for Efficiency Improvement | pt_BR |
Type | Article | pt_BR |
DOI | 10.2147/OAEM.S256220 | |
Abstract | Purpose: Patients with community-acquired pneumonia (CAP) at low risk of death by CURB-65 scoring system are usually unnecessarily treated as inpatients generating additional economic and clinical burden. We aimed to implement an evidence-based clinical pathway to reduce hospital admissions of low-risk CAP and investigate factors related to mortality and readmissions within 30 days.
Patients and methods: From November 2015 to August 2017, a clinical pathway was implemented at 20 hospitals. We included patients aged >18 years, with a diagnosis of CAP by the attendant physician. The main outcome was the monthly proportion of low-risk CURB-65 admission after the implementation of the clinical pathway. Logistic regression models were performed to assess variables associated with mortality and readmission in the admitted population within 30 days.
Results: We included 10,909 participants with suspected CAP. The proportion of low-risk CAP admitted decreased from 22.1% to 12.8% in the period. Among participants with low risk, there has been no perceptible increase in deaths (0.80%) or readmissions (6.92%). Regression analysis identified that CURB-65 variables, presence of pleural effusion (OR= 1.74; 95%CI=1.08-2.8; p=0.02) and leucopenia (OR= 2.47; 95%CI=1.11-5.48; p=0.02) were independently associated with 30-day mortality, whereas a prolonged hospital stay (OR= 2.09; 95%CI=1.14-3.83; p=0.01) was associated with 30-day readmission in the low-risk population.
Conclusion: The implementations of a clinical pathway diminished the proportion of low-risk CAP admissions with no apparent increase in clinical outcomes within 30 days. Nonetheless, additional factors influence the clinical decision about the site of care management in low-risk CAP. | pt_BR |
Affilliation | Fundação Oswaldo Cruz. Instituto Nacional de Infectologia Evandro Chagas. Laboratório de Pesquisa Clínica em DST/AIDS. Rio de Janeiro, RJ, Brasil. | pt_BR |
Affilliation | Amil Assistencia Médica Internacional. Inteligência Clínica. Rio de Janeiro, RJ, Brasil. | pt_BR |
Affilliation | Amil Assistencia Médica Internacional. Inteligência Clínica. Rio de Janeiro, RJ, Brasil. | pt_BR |
Affilliation | Amil Assistencia Médica Internacional. Departamento de Analítica. Rio de Janeiro, RJ, Brasil. | pt_BR |
Affilliation | University of Calgary. Emergency Medicine. Calgary, Canada. | pt_BR |
Affilliation | United Healthcare Global. Missouri, USA. | pt_BR |
Subject | Community-acquired pneumonia | pt_BR |
Subject | Hospitalization | pt_BR |
Subject | Mortality | pt_BR |
Subject | Readmission | pt_BR |