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首页> 外文期刊>Open access Emergency Medicine >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
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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

机译：在巴西私营卫生系统中患有社区收购肺炎患者减少临床途径的临床途径：观察队列研究和有前途的效率改善工具

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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.
机译：目的：通过Curb-65评分系统低至死亡风险的社区获得的肺炎（CAP）的患者通常不必要地被视为存在额外的经济和临床负担的住院患者。我们旨在实施一种循证的临床途径，以减少低风险概率的医院入学，并在30天内调查与死亡率和入院有关的因素。患者及方法：2015年11月至2017年8月，临床途径在20家医院实施。我们包括18岁的患者，通过助理医师诊断盖帽。主要结果是在实施临床途径后的低风险凝乳-65入学的每月比例。进行逻辑回归模型以在30天内评估与入院人群中的死亡率和入院相关的变量。结果：我们包括疑似帽的10,909名参与者。低风险概率的比例在该期间录取的22.1％降至12.8％。在风险低的参与者中，死亡人数（0.80％）或入伍（6.92％）没有可察觉的增加。回归分析鉴定了Curb-65变量，胸腔积液的存在（或= 1.74; 95％CI = 1.08- 2.8; p = 0.02）和白细胞（或= 2.47; 95％CI = 1.11- 5.48; p = 0.02）与30天的死亡率独立相关，而延长的住院住宿（或= 2.09; 95％CI = 1.14- 3.83; P = 0.01）与低风险群体的30天的再次入院有关。结论：临床途径的实施减少了低风险帽入院的比例在30天内没有明显增加的临床结果。尽管如此，额外的因素会影响低风险帽的护理管理部位的临床决策。

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