Development and Implementation of a Clinical Pathway to Reduce Inappropriate Admissions Among Patients with Community-Acquired Pneumonia in a Private Health System in Brazil: An Observational Cohort Study and a Promising Tool for Efficiency Improvement

Bibliographic Details
Main Author: Moreira, Rodrigo C.
Publication Date: 2020
Other Authors: Mendonca-Filho, Hugo T., Farias, Ayla M., Sznejder, Henry, Lang, Eddy, Wilson, Margaret M.
Format: Article
Language: eng
Source: Repositório Institucional da FIOCRUZ (ARCA)
Download full: https://www.arca.fiocruz.br/handle/icict/44881
Summary: Fundação Oswaldo Cruz. Instituto Nacional de Infectologia Evandro Chagas. Laboratório de Pesquisa Clínica em DST/AIDS. Rio de Janeiro, RJ, Brasil.
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spelling Moreira, Rodrigo C.Mendonca-Filho, Hugo T.Farias, Ayla M.Sznejder, HenryLang, EddyWilson, Margaret M.2020-12-15T11:45:13Z2020-12-15T11:45:13Z2020MOREIRA, Rodrigo C. et al. Development and Implementation of a Clinical Pathway to Reduce Inappropriate Admissions Among Patients with Community-Acquired Pneumonia in a Private Health System in Brazil: An Observational Cohort Study and a Promising Tool for Efficiency Improvement. Open Access Emergency Medicine, v. 12, p. 181-191, 2020.1179-1500https://www.arca.fiocruz.br/handle/icict/4488110.2147/OAEM.S256220engDove Medical PressDevelopment and Implementation of a Clinical Pathway to Reduce Inappropriate Admissions Among Patients with Community-Acquired Pneumonia in a Private Health System in Brazil: An Observational Cohort Study and a Promising Tool for Efficiency Improvementinfo:eu-repo/semantics/publishedVersioninfo:eu-repo/semantics/articleFundação Oswaldo Cruz. Instituto Nacional de Infectologia Evandro Chagas. Laboratório de Pesquisa Clínica em DST/AIDS. Rio de Janeiro, RJ, Brasil.Amil Assistencia Médica Internacional. Inteligência Clínica. Rio de Janeiro, RJ, Brasil.Amil Assistencia Médica Internacional. Inteligência Clínica. Rio de Janeiro, RJ, Brasil.Amil Assistencia Médica Internacional. Departamento de Analítica. Rio de Janeiro, RJ, Brasil.University of Calgary. Emergency Medicine. Calgary, Canada.United Healthcare Global. Missouri, USA.Purpose: Patients with community-acquired pneumonia (CAP) at low risk of death by CURB-65 scoring system are usually unnecessarily treated as inpatients generating additional economic and clinical burden. We aimed to implement an evidence-based clinical pathway to reduce hospital admissions of low-risk CAP and investigate factors related to mortality and readmissions within 30 days. Patients and methods: From November 2015 to August 2017, a clinical pathway was implemented at 20 hospitals. We included patients aged >18 years, with a diagnosis of CAP by the attendant physician. The main outcome was the monthly proportion of low-risk CURB-65 admission after the implementation of the clinical pathway. Logistic regression models were performed to assess variables associated with mortality and readmission in the admitted population within 30 days. Results: We included 10,909 participants with suspected CAP. The proportion of low-risk CAP admitted decreased from 22.1% to 12.8% in the period. Among participants with low risk, there has been no perceptible increase in deaths (0.80%) or readmissions (6.92%). Regression analysis identified that CURB-65 variables, presence of pleural effusion (OR= 1.74; 95%CI=1.08-2.8; p=0.02) and leucopenia (OR= 2.47; 95%CI=1.11-5.48; p=0.02) were independently associated with 30-day mortality, whereas a prolonged hospital stay (OR= 2.09; 95%CI=1.14-3.83; p=0.01) was associated with 30-day readmission in the low-risk population. Conclusion: The implementations of a clinical pathway diminished the proportion of low-risk CAP admissions with no apparent increase in clinical outcomes within 30 days. Nonetheless, additional factors influence the clinical decision about the site of care management in low-risk CAP.Community-acquired pneumoniaHospitalizationMortalityReadmissioninfo:eu-repo/semantics/openAccessreponame:Repositório Institucional da FIOCRUZ (ARCA)instname:Fundação Oswaldo Cruz (FIOCRUZ)instacron:FIOCRUZLICENSElicense.txtlicense.txttext/plain; charset=utf-83099https://www.arca.fiocruz.br/bitstream/icict/44881/1/license.txt586c046dcfeef936e32f0323bb9a47c0MD51ORIGINALDevelopment_Rodrigo_Moreira_etal_INI_2020.pdfDevelopment_Rodrigo_Moreira_etal_INI_2020.pdfapplication/pdf2378044https://www.arca.fiocruz.br/bitstream/icict/44881/2/Development_Rodrigo_Moreira_etal_INI_2020.pdf4c42c6b1e9f99faa35e527297dc75f11MD52TEXTDevelopment_Rodrigo_Moreira_etal_INI_2020.pdf.txtDevelopment_Rodrigo_Moreira_etal_INI_2020.pdf.txtExtracted 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dc.title.pt_BR.fl_str_mv Development and Implementation of a Clinical Pathway to Reduce Inappropriate Admissions Among Patients with Community-Acquired Pneumonia in a Private Health System in Brazil: An Observational Cohort Study and a Promising Tool for Efficiency Improvement
title Development and Implementation of a Clinical Pathway to Reduce Inappropriate Admissions Among Patients with Community-Acquired Pneumonia in a Private Health System in Brazil: An Observational Cohort Study and a Promising Tool for Efficiency Improvement
spellingShingle Development and Implementation of a Clinical Pathway to Reduce Inappropriate Admissions Among Patients with Community-Acquired Pneumonia in a Private Health System in Brazil: An Observational Cohort Study and a Promising Tool for Efficiency Improvement
Moreira, Rodrigo C.
Community-acquired pneumonia
Hospitalization
Mortality
Readmission
title_short Development and Implementation of a Clinical Pathway to Reduce Inappropriate Admissions Among Patients with Community-Acquired Pneumonia in a Private Health System in Brazil: An Observational Cohort Study and a Promising Tool for Efficiency Improvement
title_full Development and Implementation of a Clinical Pathway to Reduce Inappropriate Admissions Among Patients with Community-Acquired Pneumonia in a Private Health System in Brazil: An Observational Cohort Study and a Promising Tool for Efficiency Improvement
title_fullStr Development and Implementation of a Clinical Pathway to Reduce Inappropriate Admissions Among Patients with Community-Acquired Pneumonia in a Private Health System in Brazil: An Observational Cohort Study and a Promising Tool for Efficiency Improvement
title_full_unstemmed Development and Implementation of a Clinical Pathway to Reduce Inappropriate Admissions Among Patients with Community-Acquired Pneumonia in a Private Health System in Brazil: An Observational Cohort Study and a Promising Tool for Efficiency Improvement
title_sort Development and Implementation of a Clinical Pathway to Reduce Inappropriate Admissions Among Patients with Community-Acquired Pneumonia in a Private Health System in Brazil: An Observational Cohort Study and a Promising Tool for Efficiency Improvement
author Moreira, Rodrigo C.
author_facet Moreira, Rodrigo C.
Mendonca-Filho, Hugo T.
Farias, Ayla M.
Sznejder, Henry
Lang, Eddy
Wilson, Margaret M.
author_role author
author2 Mendonca-Filho, Hugo T.
Farias, Ayla M.
Sznejder, Henry
Lang, Eddy
Wilson, Margaret M.
author2_role author
author
author
author
author
dc.contributor.author.fl_str_mv Moreira, Rodrigo C.
Mendonca-Filho, Hugo T.
Farias, Ayla M.
Sznejder, Henry
Lang, Eddy
Wilson, Margaret M.
dc.subject.en.pt_BR.fl_str_mv Community-acquired pneumonia
Hospitalization
Mortality
Readmission
topic Community-acquired pneumonia
Hospitalization
Mortality
Readmission
description Fundação Oswaldo Cruz. Instituto Nacional de Infectologia Evandro Chagas. Laboratório de Pesquisa Clínica em DST/AIDS. Rio de Janeiro, RJ, Brasil.
publishDate 2020
dc.date.accessioned.fl_str_mv 2020-12-15T11:45:13Z
dc.date.available.fl_str_mv 2020-12-15T11:45:13Z
dc.date.issued.fl_str_mv 2020
dc.type.status.fl_str_mv info:eu-repo/semantics/publishedVersion
dc.type.driver.fl_str_mv info:eu-repo/semantics/article
format article
status_str publishedVersion
dc.identifier.citation.fl_str_mv MOREIRA, Rodrigo C. et al. Development and Implementation of a Clinical Pathway to Reduce Inappropriate Admissions Among Patients with Community-Acquired Pneumonia in a Private Health System in Brazil: An Observational Cohort Study and a Promising Tool for Efficiency Improvement. Open Access Emergency Medicine, v. 12, p. 181-191, 2020.
dc.identifier.uri.fl_str_mv https://www.arca.fiocruz.br/handle/icict/44881
dc.identifier.issn.pt_BR.fl_str_mv 1179-1500
dc.identifier.doi.none.fl_str_mv 10.2147/OAEM.S256220
identifier_str_mv MOREIRA, Rodrigo C. et al. Development and Implementation of a Clinical Pathway to Reduce Inappropriate Admissions Among Patients with Community-Acquired Pneumonia in a Private Health System in Brazil: An Observational Cohort Study and a Promising Tool for Efficiency Improvement. Open Access Emergency Medicine, v. 12, p. 181-191, 2020.
1179-1500
10.2147/OAEM.S256220
url https://www.arca.fiocruz.br/handle/icict/44881
dc.language.iso.fl_str_mv eng
language eng
dc.rights.driver.fl_str_mv info:eu-repo/semantics/openAccess
eu_rights_str_mv openAccess
dc.publisher.none.fl_str_mv Dove Medical Press
publisher.none.fl_str_mv Dove Medical Press
dc.source.none.fl_str_mv reponame:Repositório Institucional da FIOCRUZ (ARCA)
instname:Fundação Oswaldo Cruz (FIOCRUZ)
instacron:FIOCRUZ
instname_str Fundação Oswaldo Cruz (FIOCRUZ)
instacron_str FIOCRUZ
institution FIOCRUZ
reponame_str Repositório Institucional da FIOCRUZ (ARCA)
collection Repositório Institucional da FIOCRUZ (ARCA)
bitstream.url.fl_str_mv https://www.arca.fiocruz.br/bitstream/icict/44881/1/license.txt
https://www.arca.fiocruz.br/bitstream/icict/44881/2/Development_Rodrigo_Moreira_etal_INI_2020.pdf
https://www.arca.fiocruz.br/bitstream/icict/44881/3/Development_Rodrigo_Moreira_etal_INI_2020.pdf.txt
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repository.name.fl_str_mv Repositório Institucional da FIOCRUZ (ARCA) - Fundação Oswaldo Cruz (FIOCRUZ)
repository.mail.fl_str_mv repositorio.arca@fiocruz.br
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