Which Strategies Facilitate Improvement in Quality of Care for Elderly Hospitalized Pneumonia Patients

Article-at-a-Glance Background A retrospective cohort study was conducted to elucidate which hospital-based quality improvement (QI) strategies are most effective in facilitating improvement in care for patients with community-acquired pneumonia. Methods In 1999 telephone interviews were conducted with 29 acute care hospitals in Connecticut regarding their use of QI strategies for 1,234 patients at baseline and 1,081 patients at follow-up. Results Hospital-based QI strategies were grouped into two domains of implementation approach (epidemiologic and social influence). Hospitals scoring a 4 in either the epidemiologic or social influence approach (versus a score of ≤ 3) experienced a greater-than-average increase in percentage of patients with blood culture collection within 24hours of hospital presentation. Hospitals applying all four social influence QI strategies showed a greater-than-average increase in delivery of antibiotics within 8hours of patients' hospital arrival when compared with all the other hospitals combined. Discussion The finding that an increased proportion of patients receiving antibiotics within 8hours and blood cultures within 24hours of hospital arrival when the greatest numbers of hospital-based QI strategies were implemented is suggestive of a possible "dose effect" of QI.