Intermountain Press Release

Salt Lake City—More than 10 years after clinicians at Intermountain Healthcare began using standardized treatment protocols to treat pneumonia patients at all of its hospitals and clinics, a major new study shows the approach has resulted in significantly improved outcomes for patients, including lower death rates and less hospital readmissions.

The new, decade-long study of nearly 18,000 Utah pneumonia patients found that about 20 lives are saved annually in Utah through the use of these standardized protocols. Over the course of the study period it's estimated that as many as 200 lives have been saved.

The new study, published in the September issue of Chest, the official journal of the American College of Chest Physicians, is the largest of its kind to demonstrate widespread improved clinical outcomes for pneumonia patients. The joint study included clinicians from Intermountain Healthcare and experts from HealthInsight, a nationally recognized independent health quality improvement organization based in Salt Lake City.

The protocols were developed to assist clinicians to more effectively and accurately identify potential pneumonia patients, rapidly select appropriate and effective antibiotics, and administer recommended medications, regardless of where the patient is being treated in the Intermountain Healthcare system.

The findings are vital since community-acquired pneumonia continues to be a major health problem in the United States. It is the sixth-leading cause of death and one of the top causes of hospitalizations. It is also is costly to treat, last year consuming more than $10 billion in health care dollars.

The average death rate for hospitalized pneumonia patients across the country is nearly 14 percent - and is even higher among the elderly. Using the standardized pneumonia protocols, researchers found the mortality rate at Intermountain Healthcare hospitals averaged 1.3 percent lower than at other Utah hospitals.

"This is an example of best practices medicine where the optimal treatment is identified and guidelines are developed and implemented across institutional and geographical boundaries so that patients receive the same optimal care regardless of where they are treated, whether it's in a hospital emergency room, a rural clinic, or a primary care physician's office," says Dr. Nathan Dean, a pulmonary medicine specialist at Intermountain's LDS Hospital, who is principal investigator of the study.

The research team studied outcomes for all elderly patients in Utah diagnosed with community-acquired pneumonia between 1994 and 2003, comparing 30-day mortality rates between those who were treated by physicians at different Utah hospitals. Patients hospitalized at Intermountain hospitals after guideline implementation had a 30-day mortality rate averaging 14.5 percent, compared with 15.8 percent at other Utah hospitals - an eight percent relative reduction in mortality.

The percent of pneumonia patients who required readmission to the hospital within 30 days was 10.2 percent versus 11.7 percent at other Utah hospitals, about a 13 percent relative reduction. If the lower readmission rate found in the study is extrapolated to all Utah elderly pneumonia patients, about 25 hospital re-admissions could be avoided annually. The decreased admission rate would result in a saving of more than $125,000 dollars a year in Utah alone, says Dr. Dean.

The pneumonia treatment guideline was initially developed at Intermountain in 1994 after a multi-disciplinary team looking at ways to improve care for pneumonia patients found a wide variation of diagnostic and treatment practices being used throughout the Intermountain system. Initially, at some Intermountain facilities, nearly 70 different oral and intravenous antibiotics were being used to treat pneumonia patients with no correlation to optimal clinical outcomes.

The guideline was first initiated in three rural Utah Intermountain hospitals and clinics in early 1995 and later expanded to other rural hospitals and urban facilities. By the end of 1997, the protocols were implemented in 16 of the 17 Intermountain hospitals in Utah, including emergency departments and hospital-based clinics, as well as outpatient facilities, such as InstaCare clinics.

"Previously, a pneumonia patient could go to one of our hospitals and receive treatment that was very different than he or she would receive at another facility. There was a lot of variation not related to differences in patients," says Dr. Dean. "Now, regardless of whether a pneumonia patient is treated at one of our rural clinics or urban hospitals, they receive the same optimal treatment through the use of the clinical guideline. This reflects the ability of an integrated healthcare system to standardize and improve patient outcomes."

Key to the clinical guideline is a standardized initial risk assessment based on age, co-existing illnesses, and physical and laboratory abnormalities. Pneumonia patients, with less than two risk factors are recommended for outpatient oral antibiotic treatment. Those with two or more risk factors are evaluated for hospital admission or outpatient treatment with additional therapy.

The standardized guideline was developed by combining local "best" practices with recommendations from American Thoracic Society. Caregivers reviewed local data, user suggestions, and newly published information on a monthly basis in an effort to gain acceptance among primary care physicians, who deliver the majority of pneumonia care, says Dr. Kim Bateman, HealthInsight's vice president of medical affairs for Utah.

"A key part of this process was reporting outcome data back to the health care providers who are providing the care so that they could actually see the quality improvements being made with the use of this guideline," says Dr. Bateman.

Medicare quality improvement organizations like HealthInsight are working throughout the United States to similarly improve care of pneumonia patients, and applaud the standardized treatment approach taken by Intermountain, adds Dr. Bateman.

"This study adds further evidence that a standardized treatment approach for pneumonia patients is having a positive impact on all of our patients and helping to reduce deaths," says Dr. Dean.

The study was funded by a grant from the Deseret Foundation and HealthInsight. Members of the research team include: Dr. Dean; Dr. Bateman; Steven M. Donnelly; Michael P. Silver; Greg L. Snow; and David Hale.