Clinical pathway care improves outcomes among patients hospitalized for community-acquired pneumonia

Ann Epidemiol. 2004 Oct;14(9):669-75. doi: 10.1016/j.annepidem.2004.01.003.


Purpose: To examine the impact of a unique evidence-based clinical pathway on six outcomes of care in patients hospitalized for community-acquired pneumonia (CAP).

Methods: A retrospective cohort study of CAP patients discharged between January 1999 and December 2001, from 31 Adventist Health System institutions nationwide. A total of 22,196 records were available for multivariate analyses. Odds ratios (OR) for the outcomes were calculated and stratified by a unique severity score. The severity score ranged from 1 to 5, where 5 indicated the most severe condition.

Results: Pathway patients were significantly less likely to die in-hospital compared with non-pathway patients in four of the five severity strata (OR in severity level 1=0.37; 95% confidence interval [CI], 0.20-0.70). In all severity strata, pathway patients were approximately twice as likely as non-pathway patients to receive blood cultures and appropriate antibiotic therapy. Among patients who were classified as severity level 1, pathway patients experienced an 80% reduction in the odds of respiratory failure requiring mechanical ventilation (OR=0.20; 95% CI, 0.12-0.33).

Conclusions: Patients who were placed on pneumonia clinical pathway care were much more likely than non-pathway patients to have favorable outcomes of care.

Publication types

  • Multicenter Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Community-Acquired Infections / mortality
  • Community-Acquired Infections / therapy*
  • Critical Pathways*
  • Evidence-Based Medicine
  • Female
  • Guideline Adherence
  • Hospital Mortality
  • Hospitals, Religious / standards*
  • Humans
  • Male
  • Middle Aged
  • Multi-Institutional Systems / standards
  • Outcome and Process Assessment, Health Care*
  • Pneumonia / mortality
  • Pneumonia / therapy*
  • Quality Assurance, Health Care
  • Retrospective Studies
  • United States / epidemiology