J Clin Outcomes Manage
Comparison of 3 techniques for implementing a guideline for community-acquired pneumonia
Volturo GA, Mangolds VB, Mazzola JL, DeBellis RJ, Schaefer OP
Abstract Objective: To compare 3 techniques used in implementing a community-acquired pneumonia (CAP) guideline: traditional educational sessions, academic detailing, and preprinted order forms. Setting and participants: Patients with CAP receiving care at an academic medical center in central Massachusetts. Methods: A retrospective analysis of medical records was performed to assess guideline adherence. Results: 587 patients with CAP were identified; 71 were excluded because their primary diagnosis was not CAP. After traditional guideline education, 29% of patients were treated according to the guideline, with 75% treated with preferred formulary antibiotics. Following academic detailing, 24% of patients were treated according to the guideline, with 71% treated with formulary antibiotics. Following implementation of preprinted order forms, 38% of patients were treated according to the guideline, with 77% treated with formulary antibiotics. Conclusion: Overall, guideline adherence was suboptimal for all interventions at both sites. Formulary adherence was better, with nearly three quarters of patients receiving formulary-designated antibiotics. Implementation of preprinted orders was associated with high utilization of appropriate antibiotic therapy.
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