COMMUNITY
ACQUIRED PNEUMONIA CLINICAL
PRACTICE
GUIDELINES TEAM
https://kaiserpapers.com/downey/cajud/pnue/
CLINICAL
LEADER
Mark
Clark, MD,HBS,Vallejo
CPG
TEAM
David
Goya, MD, Pulmonology, Santa Clara
Chinh
Le, MD, Infectious Disease, Santa Rosa
Nada
Ferns, NP, Medicine, Hayward
PROJECT
MANAGEMENT
Jay
Krishnaswamy, MBA, TPMG Department of Quality and
Utilization
Linda
Rogers, MPA, TPMG Department of Quality and Utilization
EDITING
The
Medical Editing Department,
Kaiser
Foundation Research Institute
REVIEWERS
Norman
Absar, MD, HBS, Vallejo
Henry
Brodkin, MD, Medicine, Redwood City
Melanio
Castro, MD, HBS, Stockton
Doug
Chartier, MD, HBS, Oakland
Deborah
Chiarucci, MD, HBS, Redwood City
Diane
Craig, MD, HBS, Santa Clara
Mike
Driscoll, DO, HBS, Sacramento
Louis
Edelson, MD, HBS, Hayward
Paul
Feigenbaum, MD, Medicine, San Francisco
Jerry
Fessler, MD, HBS, Stockton
John
Fitzgibbon, MD, HBS, Sacramento
Lauren
Freeman, MD, HBS, South Sacramento
William
Geisser, MD, HBS, Fresno
Dale
Grahn, MD, HBS, Park Shadelands
Brian
Hoberman, MD, HBS, San Francisco
Jianfei
Hu, MD, HBS, Walnut Creek
Aye
Koko, MD, HBS, Fresno
Pansy
Kwong, MD, Medicine, Oakland
Lewis
Lehman, MD, HBS, San Francisco
Janice
Manjuck, MD, HBS, San Francisco
Greg
Matsubara, MD, HBS, Fresno
Susanne
Mierendorf, MD, HBS, Santa Clara
Joseph
Murphy, MD, Medicine, South San Francisco
Bein
Nguyen, MD, HBS, Santa Teresa
Keith
Palmer, MD, HBS, San Francisco
Rita
Patel, MD, HBS, Hayward
Andrew
Pollock, MD, HBS, Sacramento
Robert
Reisenfeld, MD, HBS, Walnut Creek
Thomas
Tang, MD, HBS, Redwood City
Tien
Trinh, MD, HBS, Santa Teresa
Than
Tran, MD, HBS, Stockton
Abdul
Wali, MD, HBS, Walnut Creek
Albert
Wilbum, MD, HBS, Fresno
Thein
Win, MD, HBS, Walnut Creek
Joseph
Wong, MD, HBS, Stockton
Terry
Woodard, MD, HBS, Santa Rosa
DESIGN
& PRODUCTION
Gail
Holan. Curvey
To
obtain more information about KPNC Clinical
Practice Guidelines, printed
copies, or permission to
reproduce
any portion, please
contact TPMG
Department
of Quality
& Utilization at 510-987-2950
or tie-line 8-427-2950, or
send an e-mail message to
clinical.guidelines@ncal.kaiperm.org.
Within the
KPNC
Lotus Notes network mail
to clinical guidelines
or kpnc-cpg.
KPNC
Clinical Practice
Guidelines can be viewed on-
line on the Kaiser Permanente
Northern California
intranet
website at
http://clinical-library.ca.kp.org.
Ratified
by the Operations Management Group and
the Quality
Oversight Committee
Copyright
1998 The Permanente
Medical Group, Inc.
CLINICAL PRACTICE GUIDELINES FOR COMMUNITY ACQUIRED PNEUMONIA
Hospital
based physicians and clinician-managers
can be
guided by admission criteria, evaluaton
and treatment recommendations,
discharge criteria, expected
measurable quality outcomes (such
as cure rate or mortality
rate), and utilization outcomes
(such as length of stay) 1 Understanding
of these issues as they
pertain to community acquired
pneumonia (CAP) has progressed, in recent
years, to the point that
certain evidence-based recommendations
and predictions can be confidently
made.
We can now
predict, based upon the initial
history, physical
findings, and laboratory evaluation,
which
patients are likely to benefit from hospitalization
for community acquired pneumonia.2 This
has
led to a set of well validated admission criteria
for CAP, and allows us to forecast expected
mortality
and length of stay based on the risk of mortality
estimated at the time of admission.
Such
a risk-adjusted approach takes into account the
presence of other comorbid conditions, which
may
also be active 3, 4, 5 Thus, these
recommendations
and predictions are applicable to the
complicated
patients with CAP in our hospitals today.
Certain interventions, such as early IV antibiotic
administration and obtaining of
blood cultures have been
shown to have a beneficial effect on outcomes6Recommendations
based on
such evidence, and on strong consensus among treating
physicians
form the basis of this guideline. Where scientific
evidence or strong consensus does not exist,
no
recommendations have been made. Where evidence does
exist (e.g., in the admission decision or "door to needle time") such
recommendations
are given special prominence and may
become the focus of quality monitoring.7
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