Public Reporting Of Pneumonia Antibiotic Timing Has Not Resulted In Adverse Effects
In 2004, the Hospital Quality Alliance (HQA) began publicly reporting hospitals’ performance on 10 quality measures. One measure, the percentage of patients admitted to a hospital with pneumonia who are given antibiotics within four hours of arriving, was considered controversial because of concerns that patients would suffer unintended consequences as hospitals tried to improve their scores. Now, researchers at Brigham and Women’s Hospital (BWH), have studied the nationwide effects of this measure on patient care for the first time. Their results are published online in the American Journal of Managed Care.
Researchers, led by Dr. Mark Friedberg at Brigham and Women’s Hospital, found no evidence that publicly reporting hospital performance on this quality measure resulted in adverse effects for patients seeking care in hospital emergency departments (ED). “Public reporting of the antibiotic timing measure did not appear to lead to over diagnosis of pneumonia, excessive antibiotic use, or inappropriate prioritization for patients coming to hospital emergency departments with respiratory symptoms,” said Friedberg.
In 2007, due to concerns about the potential for diagnostic errors, antibiotic resistance, and other adverse side effects of unnecessary antibiotic use, the HQA’s window for giving antibiotics to patients with pneumonia was lengthened from four hours to six hours.
“It can be difficult to diagnose a patient with pneumonia within four hours, especially in a busy ED,” said Friedberg. “Some policy makers were worried that if emergency physicians were focused too closely on pneumonia, other respiratory conditions might be missed. Additionally, there were concerns that patients who were more likely to have pneumonia would be fast tracked through the ED, resulting in longer wait times for other patients.”
Friedberg and colleagues set out to detect evidence of these unintended consequences in a nationally representative sample of more than 13,000 patient visits to approximately 400 hospital EDs. The researchers evaluated data from before and after the start of public reporting on the antibiotic timing measure. They asked three questions:
1. Did the rate of pneumonia diagnosis for patients with cough, shortness of breath and difficulty breathing increase?
2. Were patients with cough, shortness of breath and difficulty breathing more likely to receive antibiotics after reporting began?
3. Did waiting times for patients with respiratory symptoms decrease, relative to patients less likely to have pneumonia?
They found that:
1. Rates of pneumonia diagnosis did not increase after reporting.
2. Rates of patients who received antibiotics with pneumonia symptoms did not increase.
3. Waiting times in the ED increased by similar amounts for patients with and without respiratory symptoms.
When looking for differences between ED visits to hospitals with higher and lower scores on the antibiotic timing measure, researchers found that the major difference was the length of time patients waited to see a doctor. On average, patients waited 38 minutes at the highest-scoring hospitals, compared with 66 minutes at the lowest-scoring hospitals.
“It was interesting to find that by comparing two hospitals’ publicly reported scores on pneumonia antibiotic timing, you could potentially make a good guess about whether one ED will have a longer waiting time than the other,” said Friedberg. “This information is not publicly reported anywhere else.”