1319. Few Patients Receive HCAP Care in Accordance with ATS Guidelines: Surprising Findings from a Large National Database
Session: Oral Abstract Session: Clinical Management of Infectious Disease
Saturday, October 20, 2012: 10:45 AM
Room: SDCC 26 AB
Background: The ATS guidelines for management of adults with Healthcare-Associated Pneumonia (HCAP) were published in 2005, and remain controversial.  The extent to which physicians have adopted these practices is unknown.  

Methods: We performed a retrospective cohort study at 346 hospitals participating in Premier’s Perspective database from 07/2007- 06/2010. We included all adults with an ICD-9 code for pneumonia as principal diagnosis, or as a secondary diagnosis paired with a principal diagnosis of respiratory failure or sepsis.  To ensure patients had pneumonia, we required a radiographic study and antibiotic administration within 48 hours; plus ≥1 HCAP factor: hospitalization in prior 90 days, hemodialysis, admission from a skilled nursing facility (SNF), or immune suppression. We defined ATS-concordant care as receipt of 1 antibiotic targeting MRSA plus 2 targeting Pseudomonas, started within 48 hours of admission.  Care was deemed partially concordant if 1 antibiotic targeting MRSA plus 1 targeting Pseudomonas were given.  Other combinations were deemed discordant.  We examined patient and hospital characteristics associated with guideline-concordant care.

Results: Of 85,097 patients with HCAP, 14,809 (17.4%) received fully concordant, 17,140 (20.1%) received partially concordant, and 53,148 (62.5%) received discordant antibiotics. Patients admitted from a SNF or with ≥ 2 risk factors for HCAP were more likely to receive concordant care.  Patients who received concordant antibiotics were younger (p<.0001), more likely to have a principal diagnosis of sepsis or respiratory failure (p<.0001), or be admitted to ICU (p<.0001). Urban, teaching, and large (>400 beds) hospitals were more likely to provide concordant care (p<.0001).  Hospitals differed in likelihood of providing concordant or partially concordant care (median rate 31.5%, IQR 21.1 – 43.9 %).  Among patients who received HCAP-discordant care, 81.6% were treated according to Community-aquired Pneumonia (CAP) guidelines instead.

Conclusion: In this large cohort study fewer than one-half of HCAP patients received guideline-concordant care.  Just over one-half the HCAP patients were treated according to CAP guidelines instead.

Sarah Haessler, MD1, Peter Lindenauer, MD, MSc2, Penelope Pekow, PhD3, Aruna Priya, MA, MSc2, Raquel Belforti, DO4, Tara Lagu, MD, MPH2, Marya Zilberberg, MD, MPH5, Daniel Skiest, MD1 and Michael Rothberg, MD, MPH4, (1)Infectious Diseases, Baystate Medical Center, Springfield, MA, (2)Center for Quality of Care Research, Baystate Medical Center, Springfield, MA, (3)Biostatistics and Epidemiology Department, School of Public Health and Health Sciences, University Of Massachusetts, Amherst, MA, (4)General Internal Medicine, Baystate Medical Center, Springfield, MA, (5)University of Massachusetts and EviMed Research Group, LLC, Goshen, MA

Disclosures:

S. Haessler, None

P. Lindenauer, None

P. Pekow, None

A. Priya, None

R. Belforti, None

T. Lagu, None

M. Zilberberg, None

D. Skiest, None

M. Rothberg, None

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