Waterer Grant, Bennett Lesley
aUniversity of Western Australia, Perth, WA, Australia bNorthwestern University, Chicago, Illinois, USA cRoyal Perth Hospital, Perth, Western Australia, Australia.
Curr Opin Pulm Med. 2015 May;21(3):219-25. doi: 10.1097/MCP.0000000000000155.
We are entering into a new era of healthcare wherein patient outcomes are increasingly being publicly reported, not just by institution, but by individual clinicians. This review focuses on the issue of quality of care of patients with community-acquired pneumonia (CAP), in particular the choice of outcome, quality of data needed and recommendations of the current bundle of care suggested by the available literature as delivering the best chance of favourable outcomes for patients.
There is increasing evidence that pneumonia outcomes have improved over the past decade, particularly mortality. However, we have been oversimplistic in setting quality targets and that a bundle of care is required to deliver best outcomes, such as has been shown with the surviving sepsis campaign. Equally, the quality of data available to compare outcomes needs to be significantly improved on what is currently available.
To achieve best outcomes for their patients, physicians must be actively comparing their outcomes against other institutions and not rely on historical data. A bundle of care that includes rapid administration of antibiotics, use of combination antibiotic therapy including a macrolide and early mobilization is a good starting point.
我们正步入医疗保健的新时代，在此时代，不仅机构，个体临床医生的患者治疗结果也越来越多地被公开报告。本综述聚焦社区获得性肺炎（CAP）患者的医疗质量问题，尤其是结局的选择、所需数据的质量以及现有文献所建议的当前一整套护理措施，这些措施被认为能为患者带来获得良好结局的最佳机会。
越来越多的证据表明，在过去十年中肺炎的治疗结果有所改善，尤其是死亡率。然而，我们在设定质量目标时过于简单化，并且需要一整套护理措施才能实现最佳结局，就像脓毒症存活行动所显示的那样。同样，用于比较结局的现有数据质量需要在当前可用数据的基础上显著提高。
为了让患者获得最佳结局，医生必须积极将自己的治疗结果与其他机构进行比较，而不是依赖历史数据。包括快速使用抗生素、使用包括大环内酯类药物在内的联合抗生素治疗以及早期活动在内的一整套护理措施是一个良好的起点。
