Management of community-acquired pneumonia and secular trends at different hospitals

Study objetives: The goal of this study was to assess variability in the management of patients admitted to hospitals with community-acquired pneumonia (CAP), and changes in secular trends of this condition. Methods: Observational study carried out, in 5 teaching hospitals, in northern Spain of patients admitted with CAP between March 1,1998 and March 1,1999 (baseline period), and between March 1, 2000 and September 30, 2001 (follow-up period). Clinical histories were analyzed retrospectively for relevant parameters for process-of-care and outcome performance. Those parameters among hospitals during the baseline period were compared. For each hospital, changes in these parameters between baseline and follow-up were also measured. All parameters were adjusted for disease severity. Results: A total of 844 patients were included in the baseline period, and 654 in the follow-up period. During the baseline period, adjusted analyses revealed statistically significant differences in all process-of-care parameters except the coverage of atypical pathogens. With regard to clinical outcomes, however, only the 30-day readmission rate was significantly different (P = 0.03). Adjusted mean length of stay ranged from 6.3 to 9.2 days (P<0.0001). In adjusted analyses of temporal changes within hospitals for process-of-care and outcome performance, revealed few statistically significant differences. Conclusions: Variability discovered between hospitals in the management of patients in the absence of relevant secular changes in each hospital points out the necessity to implement measures designed to reduce such variability between hospitals and to improve the quality of medical treatment. (C) 2004 Elsevier Ltd. All rights reserved.