RESUMEN
OBJECTIVE: Variability in the management of patients hospitalized with community-acquired pneumonia (CAP) is attributable to many factors. The objective of this study was to determine whether such variability is influenced by the medical specialty area where the patient is treated. PATIENTS AND METHODS: The treatment and outcomes for a random sample of patients with CAP admitted to 4 hospitals over 2 periods (1 year starting March 1, 1998, and 1.5 years starting March 1, 2000) were compared by medical specialty department. Multiple linear and logistic regression models were used to analyze differences. RESULTS: Differences were found between departments in the coverage of atypical pathogens (P<.001). The adjusted mean length of stay in hospital varied between 6.8 and 9.1 days (P<.01), and the duration of intravenous treatment varied between 4.6 and 7.3 days (P<.05). Adjusted models showed that mortality in hospital and at 30 days was significantly higher for patients treated in internal medicine departments (odds ratios, 2.1 and 2, respectively) than for those treated in pulmonology departments. CONCLUSIONS: Interdepartmental differences were observed in how patients hospitalized with CAP were treated and in the outcomes achieved. This variation is probably influenced by the differences that were found in the use of antibiotics.
Asunto(s)
Antibacterianos/uso terapéutico , Manejo de Caso , Infecciones Comunitarias Adquiridas/tratamiento farmacológico , Medicina , Grupo de Atención al Paciente , Neumonía/tratamiento farmacológico , Especialización , Adolescente , Adulto , Anciano , Combinación Amoxicilina-Clavulanato de Potasio/uso terapéutico , Antibacterianos/administración & dosificación , Antibacterianos/clasificación , Infecciones Comunitarias Adquiridas/complicaciones , Infecciones Comunitarias Adquiridas/epidemiología , Comorbilidad , Quimioterapia Combinada/uso terapéutico , Utilización de Medicamentos/estadística & datos numéricos , Femenino , Departamentos de Hospitales , Mortalidad Hospitalaria , Hospitalización , Hospitales de Enseñanza/estadística & datos numéricos , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Neumonía/complicaciones , Neumonía/epidemiología , Pautas de la Práctica en Medicina/estadística & datos numéricos , Estudios Retrospectivos , Choque Séptico/etiología , Choque Séptico/mortalidad , España/epidemiología , Resultado del TratamientoRESUMEN
Objetivo: La variabilidad en el manejo de los pacientes ingresados por una neumonía adquirida en la comunidad (NAC) es multifactorial. Nuestro objetivo fue comprobar si en ello influye la especialidad del servicio responsable. Pacientes y métodos: Se compararon entre servicios el tratamiento y los resultados de una muestra aleatoria de los pacientes ingresados por NAC en 4 hospitales durante 2 períodos (un año desde el 1 de marzo de 1998; un año y medio desde el 1 de marzo de 2000). Se emplearon modelos de regresión lineal múltiple y logística para ajustar las diferencias. Resultados: Se encontraron diferencias entre servicios en la cobertura de gérmenes atípicos (p < 0,001). La duración media ajustada de la estancia hospitalaria osciló entre 6,8 y 9,1 días (p < 0,01) y la del tratamiento intravenoso entre 4,6 y 7,3 días (p < 0,05). Los análisis ajustados demostraron que la mortalidad intrahospitalaria y a los 30 días fue significativamente superior en los servicios de medicina interna (odds ratio: 2,1 y 2, respectivamente) respecto a los de neumología. Conclusiones: Se observaron diferencias entre servicios en el tratamiento de los pacientes ingresados por NAC y en sus resultados. Es probable que en ello influyan las diferencias encontradas en la utilización de los antibióticos
Objective: Variability in the management of patients hospitalized with community-acquired pneumonia (CAP) is attributable to many factors. The objective of this study was to determine whether such variability is influenced by the medical specialty area where the patient is treated. Patients and Methods: The treatment and outcomes for a random sample of patients with CAP admitted to 4 hospitals over 2 periods (1 year starting March 1, 1998, and 1.5 years starting March 1, 2000) were compared by medical specialty department. Multiple linear and logistic regression models were used to analyze differences. Results: Differences were found between departments in the coverage of atypical pathogens (P<.001). The adjusted mean length of stay in hospital varied between 6.8 and 9.1 days (P<.01), and the duration of intravenous treatment varied between 4.6 and 7.3 days (P<.05). Adjusted models showed that mortality in hospital and at 30 days was significantly higher for patients treated in internal medicine departments (odds ratios, 2.1 and 2, respectively) than for those treated in pulmonology departments. Conclusions: Interdepartmental differences were observed in how patients hospitalized with CAP were treated and in the outcomes achieved. This variation is probably influenced by the differences that were found in the use of antibiotics