Reporting Hospitals Antibiotic Timing in Pneumonia

Adverse Consequences for Patients?

Published in: The American Journal of Managed Care, v. 15, no. 2, Feb. 2009, p, 137-144, a145

Posted on RAND.org on February 01, 2009

by Mark W. Friedberg, Ateev Mehrotra, Jeffrey A. Linder

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OBJECTIVE: To determine whether publicly reporting hospital scores on antibiotic timing in pneumonia (percentage of patients with pneumonia receiving antibiotics within 4 hours) has led to unintended adverse consequences for patients. STUDY DESIGN: Retrospective analyses of 13,042 emergency department (ED) visits by adult patients with respiratory symptoms in the National Hospital Ambulatory Medical Care Survey, 2001-2005. METHODS: Rates of pneumonia diagnosis, antibiotic use, and waiting times to see a physician were compared before and after public reporting, using a nationally representative hospital sample. These outcomes also were compared between hospitals with different antibiotic timing scores. RESULTS: There were no differences in rates of pneumonia diagnosis (10% vs 11% of all ED visits, P = .72) or antibiotic administration (34% vs 35%, P = .21) before and after antibiotic timing score reporting. Mean waiting times to be seen by a physician increased similarly for patients with and without respiratory symptoms (11-minute vs 6-minute increase, respectively; P = .29). After adjustment for confounders, hospitals with higher 2005 antibiotic timing scores had shorter mean waiting times for all patients, but there were no significant score-related trends for rates of pneumonia diagnosis or antibiotic use. CONCLUSION: Despite concerns, public reporting of hospital antibiotic timing scores has not led to increased pneumonia diagnosis, antibiotic use, or a change in patient prioritization.

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