Milo Lori A, Smucker William, Logue Everett, Orosz James, Grimes Michael G, Bonyo Bonyo, Dulle David, McNaughton Marc
Department of Family Practice, Summa Health System, 525 East Market Street, Suite 290, PO Box 2090, Akron, OH 44309-2090, USA.
Am J Med Qual. 2003 Sep-Oct;18(5):214-9. doi: 10.1177/106286060301800506.
Mandatory community-acquired pneumonia (CAP) protocol usage was proposed in our community-based teaching hospital because of senior medical staff perceptions that excessive variation in CAP care was adversely affecting clinical outcomes and costs. The purpose of our study was to examine CAP process of care variation, outcomes, and costs to ascertain whether the mandatory CAP protocol could be justified. The study consisted of an analysis of administrative and sampled chart data. We looked at pneumonia severity, orders for blood cultures or sputum staining, antibiotic usage, symptom resolution, length of stay, discharge status, readmission risk by follow-up time, and financial data. We found that process of care variation was low, clinical outcomes were generally good, and CAP care was profitable. Our data suggested that the proposed mandatory CAP protocol was not necessary. Our experience supports the management principle that fact finding should usually precede decision making, not the reverse.
由于高级医务人员认为社区获得性肺炎（CAP）护理存在过度差异，对临床结果和成本产生了不利影响，因此我们这家社区教学医院提议使用强制性CAP方案。我们研究的目的是检查CAP护理过程中的差异、结果和成本，以确定强制性CAP方案是否合理。该研究包括对行政和抽样图表数据的分析。我们考察了肺炎严重程度、血培养或痰涂片检查医嘱、抗生素使用情况、症状缓解情况、住院时间、出院状态、随访期间的再入院风险以及财务数据。我们发现护理过程差异较小，临床结果总体良好，并且CAP护理是盈利的。我们的数据表明，提议的强制性CAP方案没有必要。我们的经验支持这样一个管理原则，即通常应该先进行事实调查再做决策，而不是相反。
