Influence of hospital characteristics on quality of care in patients with community-acquired pneumonia.

Straubhaar, Katrin; Schuetz, Philipp; Blum, Claudine Angela; Nigro, Nicole; Matthias, Briel; Christ-Crain, Mirjam; Mueller, Beat; Step Study, Group (2016). Influence of hospital characteristics on quality of care in patients with community-acquired pneumonia. Swiss medical weekly, 146(w14337), w14337. EMH Schweizerischer Ärzteverlag 10.4414/smw.2016.14337

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PRINCIPLES In-hospital care of patients with community-acquired pneumonia (CAP) varies across hospitals. Understanding of the underlying factors is the basis for tailored quality improvements. Using data from a randomised controlled Swiss-wide multicentre trial, we compared length of stay (LOS) and other patient outcomes according to (A) the use of a procalcitonin (PCT)-based antibiotic stewardship protocol, (B) institution type (university vs non-university), and (C) historical time period in relation to the introduction of Diagnosis Related Group (DRG) reimbursement (2012). METHODS We included 784 patients hospitalised with CAP from six institutions into this secondary analysis. We used multivariable regression models adjusted for age, comorbidities and disease severity to determine the influence of institution characteristics on LOS and patient outcomes. FINDINGS LOS was significantly shorter in the institution using a PCT-based antibiotic stewardship protocol (9.2 vs 5.3 days; adjusted mean difference 3.92 days; 95% confidence interval [CI] 5.16-2.68) with shorter antibiotic treatment. There was no difference in LOS in university vs non-university hospitals, but antibiotic courses in university-type hospitals were longer (11.0 vs 8.3 days; adjusted mean difference 2.59 days; 95% CI, 1.69-3.49). No significant difference in LOS was found when comparing the time period before and after the introduction of the DRG system in Switzerland. CONCLUSIONS We found differences in LOS associated with theuse of a PCT-based antibiotic stewardship protocol, which remained robust after multivariable adjustment. Importantly, the type of institution and model of reimbursement did not influence LOS in our CAP cohort. More health services research studies are needed to establish causal effects.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of General Internal Medicine (DAIM) > Clinic of General Internal Medicine > Centre of Competence for General Internal Medicine

Subjects:

600 Technology > 610 Medicine & health
300 Social sciences, sociology & anthropology > 360 Social problems & social services

ISSN:

1424-7860

Publisher:

EMH Schweizerischer Ärzteverlag

Language:

English

Submitter:

Jacques Donzé

Date Deposited:

12 May 2017 14:43

Last Modified:

29 Jan 2019 11:22

Publisher DOI:

10.4414/smw.2016.14337

PubMed ID:

27684181

Additional Information:

Prof. Nicolas Rondondi is a co-author of the STEP study group.

BORIS DOI:

10.7892/boris.94679

URI:

https://boris.unibe.ch/id/eprint/94679

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