Community-acquired pneumonia team decreases length of stay in hospitalized, low-risk patients with pneumonia.
Community-acquired pneumonia team decreases length of stay in hospitalized, low-risk patients with pneumonia.
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DOI：
10.3810/hp.2013.08.1063
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发表时间：
2013-08-01
影响因子：
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通讯作者：
Verea-Hernando, Hector
中科院分区：
文献类型：
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作者：
Marcos, Pedro J;Restrepo, Marcos I;Verea-Hernando, Hector
背景：改善社区获得性肺炎(CAP)低风险患者护理的团队重点干预是一个有争议的问题。我们的目的是确定社区获得性肺炎团队(CAPT)与普通肺科团队(GPT)的管理相比，是否能够缩短低风险CAP患者的住院时间(LOS)并改善卫生保健利用率。方法：我们对2007年6月至2008年6月在一家三级医院住院的低风险CAP患者(肺炎严重性指数[PSI]评分I或II级)进行了前瞻性队列研究。根据美国传染病学会(IDSA)和美国胸科学会(ATS)CAP指南的建议，研究患者由CAPT治疗组(n=35)分层管理，或由GPT(n=30)按照护理标准进行管理。比较两种不同团队重点干预措施效果的主要结果衡量标准是CAP患者的医院LOS。二次研究结果包括患者30天和90天的全原因再住院率，30天和90天的死亡率，抗生素治疗持续时间，患者从静脉(IV)转为口服抗生素治疗的时间，以及患者达到临床稳定的时间。结果：在CAPT的帮助下，住院的低风险CAP患者住院时间更短(减少9天；P<；0.001)，从静脉注射转为口服抗生素治疗的时间更短(P<0.05)。
BACKGROUND: Team-focused intervention to improve the care of low-risk patients with community-acquired pneumonia (CAP) is a matter of controversy. Our aim was to determine if a community-acquired pneumonia team (CAPT) would shorten hospital length of stay (LOS) and improve health care utilization in low-risk patients with CAP compared with management by a general pulmonary team (GPT).METHODS: We performed a prospective cohort study of hospitalized, low-risk patients with CAP (Pneumonia Severity Index [PSI] score class I or II) at a single tertiary hospital from June 2007 to June 2008. Study patients were stratified to management by the CAPT treating group (n = 35), following the Infectious Diseases Society of America (IDSA) and American Thoracic Society (ATS) CAP guideline recommendations, or to management by the GPT (n = 30) following the standard of care. Primary outcome measure for comparison of the efficacy of the 2 different team-focused interventions was hospital LOS for patients with CAP. Secondary study outcome measures included patient 30- and 90-day all-cause readmission rate, rate of mortality at 30 and 90 days, antibiotic-treatment duration, time to switch patient from intravenous (IV) to oral antibiotic treatment, and time to achieve clinical stability for patients.RESULTS: Hospitalized, low-risk patients with CAP, who were assisted by a CAPT were more likely to have a shorter hospital stay (9 days less; P < 0.001), shorter time to switch from IV to oral antibiotic therapy (8 days less; P