The rationale for using the North American antibiotic guidelines for community-acquired pneumonia (CAP) in immunocompetent patients as the basis of measurement in the study reviewed was established by the recommendations of the following bodies:
- The Centers for Disease Control and Prevention (CDC)
- The Infectious Diseases Society of America (IDSA)
- The Canadian Infectious Disease Society/Canadian Thoracic Society (CIDS/CTS),
- The American Thoracic Society (ATS)
Basis of the Rational
These recommendations resulted from the findings of all four organizations indicating that “Streptococcus pneumoniae is the most common cause of CAP, that treatment that covers ‘atypical’ pathogens (e.g., Legionella species, Chlamydia pneumoniae, Mycoplasma pneumoniae) can be associated with improved survival, and that the prevalence of antibiotic-resistant S. pneumoniae is increasing” (Grenier et al., 2011). The recommendations were used to determine antibiotic regimens for treating pneumonia for different ages and different degrees of severity.
Evidence Supporting the Need for a Measure
Additional evidence supporting the need for a method for keeping track of the percentage of those with pneumonia who receive the recommended antibiotic regimen is based on the increasing incidence of the disorder especially in those over age 64, and the high rates of morbidity and mortality due to the illness. Specific points of evidence are as follows:
- Almost 1.2 million people are hospitalized for pneumonia in the U.S. each year.
- There is a great deal of backup evidence supporting the need for such a measure to use to determine the number of individuals with pneumonia who are being placed on the recommended antibiotic. Much of it surrounds the serious nature of the illness for certain populations at higher risk for negative outcomes including death. Additionally, the incidence rate of Community Acquired Pneumonia (CAP) has been increasing such that the problem has been seen with increasing frequencies, representing a significant percentage of in-patient hospitalizations and stays in the ICU. Therefore, determining how many of these patients receive the recommended antibiotic regimen appropriate to their condition is an important determination of the degree to which best practices for care are being implemented. Additional support for the need for the measure is as follows:
- Studies into morbidity and mortality rates of pneumonia in the U.S. in the year 2004, indicated that more than 60,000 people died of the illness. There were over 700,000 people treated successful and discharged in the same year. The most successfully treated population for all types of pneumonia were those over the age of 64, representing almost 300,000 individuals.
- In the period of time from the 1980’s through the 1990’s pneumonia was found to be the sixth most common cause of death in the U.S. Rates over this period of time increased by almost 60%. This increase was largely attributed to the increase in individuals over the age of 64 in this country as well as an increase in the complexity of the illness due to many people presenting with other medical problems in addition to pneumonia.
(Statistics cited from CMS, 2013).
References
Berger, A., Edelsberg, J., Oster, G., Huang, X., & Weber, D. J. (2014). Patterns of Initial Antibiotic Therapy for Community-Acquired Pneumonia in US Hospitals, 2000 to 2009. The American journal of the medical sciences, 347(5), 347-356.
Grenier, C., Pépin, J., Nault, V., Howson, J., Fournier, X., Poirier, M. S., & Valiquette, L. (2011). Impact of guideline-consistent therapy on outcome of patients with healthcare-associated and community-acquired pneumonia. Journal of antimicrobial chemotherapy, 66(7), 1617-1624.
The Joint Commission, CMS(2013). Specifications manual for national hospital inpatient quality measures, version 4.2b. Centers for Medicare & Medicaid Services (CMS), The Joint Commission; various p.
