1、Pneumonia careControversies and ChallengesMeera Kelley MDClinical Coordinator, MRNC, Inc.The QIO for the CarolinasApril 14, 2005 1Medical Review of NC, Inc.OverviewIssues with the indicatorsOther broad challengesDiscussionApril 14, 2005 2Medical Review of NC, Inc.PN-1 Oxygenation assessment PN-2 Pne
2、umococcal vaccination PN-3b Blood cultures PN-4 Adult smoking cessation advice PN-5 Antibiotic timing PN-5a Initial antibiotic w/in 8 h hospital arrival PN-5b Initial antibiotic w/in 4 h hospital arrival PN-6a Initial antibiotic selection ICU PN-6b Initial antibiotic selection Non ICU PN-7 Influenza
3、 vaccination April 14, 2005 3Medical Review of NC, Inc.PN-1 Oxygenation assessment Inadequate oxygen (hypoxemia) is common in severe pneumonia and is a known mortality risk factor. Giving supplemental oxygen has been shown to decrease mortality among patients with pneumonia.April 14, 2005 4Medical R
4、eview of NC, Inc.Controversies & ChallengesOxygenation assessment NoApril 14, 2005 5Medical Review of NC, Inc.PN-3b Blood cultures Published pneumonia treatment guidelines recommend performance of blood cultures for all inpatients to optimize therapy. Improved survival has been associated with optim
5、al therapy. Yield is greater if the culture is collected before antibiotics are administered.April 14, 2005 6Medical Review of NC, Inc.Controversies & ChallengesBlood culturesDrawn late-after antibioticsNot drawn at all-not routinely done for outpatientsApril 14, 2005 7Medical Review of NC, Inc.PN-4
6、 Adult smoking cessation advice/counseling Smoking accounts for one out of every five deaths in the US and is the most important modifiable cause of premature death. Smoking cessation advice is clinically effective and cost-effective. Hospitalization can be an ideal opportunity for a patient to stop
7、 smoking. Patients who receive even brief smoking-cessation advice from their physicians are more likely to quit.April 14, 2005 8Medical Review of NC, Inc.Controversies & ChallengesSmoking cessation adviceDocumentationPreventive, long term issues not routinely addressed by physiciansApril 14, 2005 9
8、Medical Review of NC, Inc.PN-5 Antibiotic timing Timely administration of antibiotics = improved outcome among pneumonia patients Improved survival with receipt of antibiotics within 4 h of admission (Khan 1990) Shortening the time-to-first-dose to 4 h was associated with improved survival (McGarvey 1993) First dose of antibiotic within 3 hours -less likely to die within 30 days (Meehan 1995) 30-day mortality 10% (P=0.04) lower, length of hospital stay shorter among patients whose first antibiotic administered within 4 h (Bratzler 2001)April 14, 2005 10Medical Review of NC, Inc.
