Improving evidence-based management and outcomes in community-acquired pneumonia: Effectiveness of a multidisciplinary bundle of care

Ms Melanie Lloyd1, Dr Amalia Karahalios2, Professor Edward Janus1, Ms Stephanie Lowe1, Ms Melina Shackell1, Professor  Terry Haines3, Dr Elizabeth Skinner1, Dr  So Ko1, Dr Lucy Desmond1, Dr Anurika De Silva2, Associate Professor Harin Karunajeewa1

1Western Health, St Albans, Australia, 2University of Melbourne, Parkville, Australia, 3Monash University, Frankston, Australia

Abstract:

Aim:
To evaluate a multidisciplinary approach to management of hospitalised patients with community-acquired pneumonia (CAP), designed to improve adherence to interventions with prior proven efficacy (early mobilisation, routine malnutrition screening, routine corticosteroids, and early switch to oral antibiotics).

Design:
Pragmatic, stepped-wedge, randomised effectiveness study.

Method:
Patients hospitalised under a General Internal Medical (GIM) unit meeting a standard case-definition for CAP were eligible. Eight GIM units at two Australian hospitals were randomised to either: i) usual care, or ii) care supported by a dedicated “CAP Service”: a multidisciplinary team deploying algorithm-based implementation of four evidence-based interventions. Outcome measures included: i) length of hospital stay (LOS), ii) mortality, iii) readmission rates, and iv) compliance with evidence-based practice.

Results:
415 and 401 individuals were randomised to usual care and the CAP Service respectively. Under the CAP Service, adherence to evidence-based protocols improved across all four interventions (early mobilisation: 19% (usual care) vs. 72% (CAP Service), malnutrition screening: 55% vs. 83%, corticosteroids: 2% vs. 53%, switch to oral antibiotics: 69% vs. 77%). However, no difference in outcome was observed for LOS (predicted mean 3.5 vs 3.4 days, odds ratio [95% CI] 0.95 [0.79-1.16]), 90-day mortality (16% vs 16%, 0.92 [0.49-1.75]) or 90-day readmissions (26% vs 30%, 1.17 [0.70-1.94]).

Conclusion:
This study demonstrates an innovative, analytically robust approach to translational health services research, where effectiveness can be evaluated in a generalisable “real-world” setting. A multidisciplinary team was able to significantly increase adherence to evidence-based practice, however, there was no associated improvement in study outcomes.

Biography:

Melanie has over 10 years experience working as a Physiotherapist in Melbourne, Brisbane and the UK. Her clincial interest areas include acute illness in multimorbid individuals, exercise rehabilitation and vestibular rehabilitation. She is currently leading a program of research that aims to explore novel methodologies for evaluating interventions in highly representative patient groups, and is a PhD candidate at the University of Melbourne.