Humana HealthBeat Transcript Archive

There can be a great deal of variation in how doctors treat many conditions, including pneumonia. This variation can make a difference in how well and how quickly the patient recovers.

A study in the Journal of the American Medical Association shows that using guidelines in treating patients with pneumonia resulted in health outcomes that were as good as treatment that kept patients in the hospital longer.

Dr. Thomas Marrie and his Canadian colleagues instituted a set of management guidelines for treating community-acquired pneumonia at 9 hospitals. 10 other hospitals continued conventional pneumonia treatment.

The key elements of the "critical pathway" guidelines included:

a system to rate the severity of pneumonia
greater use of oral rather than intravenous antibiotics
use of one instead of several antibiotics
specific discharge criteria

Compared to the conventional-treatment hospitals, the hospitals adopting the critical pathway reduced hospital admission for low-risk patients by 18%, and those patients who were hospitalized were discharged nearly 2 days sooner. After 6 weeks the rates of complications, re-admissions, and death were similar in both hospital groups. But, the savings amounted to approximately 1700 U.S. dollars for each patient treated using the critical pathway guidelines.

February 9
Pneumonia and Guidelines
	There can be a great deal of variation in how doctors treat many conditions, including pneumonia. This variation can make a difference in how well and how quickly the patient recovers. A study in the Journal of the American Medical Association shows that using guidelines in treating patients with pneumonia resulted in health outcomes that were as good as treatment that kept patients in the hospital longer. Dr. Thomas Marrie and his Canadian colleagues instituted a set of management guidelines for treating community-acquired pneumonia at 9 hospitals. 10 other hospitals continued conventional pneumonia treatment. The key elements of the "critical pathway" guidelines included: a system to rate the severity of pneumonia greater use of oral rather than intravenous antibiotics use of one instead of several antibiotics specific discharge criteria Compared to the conventional-treatment hospitals, the hospitals adopting the critical pathway reduced hospital admission for low-risk patients by 18%, and those patients who were hospitalized were discharged nearly 2 days sooner. After 6 weeks the rates of complications, re-admissions, and death were similar in both hospital groups. But, the savings amounted to approximately 1700 U.S. dollars for each patient treated using the critical pathway guidelines.

	If this is better treatment, why isn't it used by all doctors? Basically, the way that doctors practice may be determined by where they went to school, when they were trained, and how well they keep up with the latest information, which can be difficult given how much information there is-and all of these factors are highly variable. Most likely there will be greater adoption of guidelines as they are proven in studies like this one and information becomes more easily available to physicians. References and Resources: Marrie TJ, Lau CY, et. al. A Controlled Trial of a Critical Pathway for Treatment of Community-Acquired Pneumonia. Journal of the American Medical Association. 2000; 283:749-755. http://jama.ama-assn.org/issues/v283n6/full/joc90727.html