Processes of care and outcomes for community-acquired pneumonia

Am J Med. 2011 Dec;124(12):1175.e9-17. doi: 10.1016/j.amjmed.2011.05.029. Epub 2011 Oct 13.


Background: Although processes of care are common proxies for health care quality, their associations with medical outcomes remain uncertain.

Methods: For 2076 patients hospitalized with pneumonia from 32 emergency departments, we used multilevel logistic regression modeling to assess independent associations between patient outcomes and the performance of 4 individual processes of care (assessment of oxygenation, blood cultures, and rapid initiation [<4 hours] and appropriate selection of antibiotic therapy) and the cumulative number of processes of care performed.

Results: Overall, 141 patients (6.8%) died. Mortality was 0.3% to 1.7% lower for patients who had each of the individual processes of care performed (P≥.13 for each comparison); mortality was 7.5% for patients who had 0 to 2 processes of care, 7.2% for those with 3 processes of care, and 5.8% for those with all 4 processes of care performed (P=.39). Mortality was not significantly associated with either individual or cumulative process measures in multivariable models.

Conclusion: Neither the individual processes of care nor the cumulative number performed is associated with short-term mortality for pneumonia.

Publication types

  • Multicenter Study
  • Randomized Controlled Trial
  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Adult
  • Aged
  • Anti-Infective Agents / therapeutic use
  • Chi-Square Distribution
  • Community-Acquired Infections / mortality*
  • Community-Acquired Infections / therapy*
  • Connecticut / epidemiology
  • Evidence-Based Medicine
  • Female
  • Guideline Adherence
  • Hospital Mortality
  • Humans
  • Logistic Models
  • Male
  • Middle Aged
  • Outcome and Process Assessment, Health Care*
  • Pennsylvania / epidemiology
  • Pneumonia / mortality*
  • Pneumonia / therapy*
  • Prognosis
  • Risk Factors
  • Severity of Illness Index
  • Statistics, Nonparametric


  • Anti-Infective Agents