Table 1.
Baseline Patient, Provider, and Site Characteristics by Total Number of Processes of Care Performed*
| Cumulative No. of Processes of Care Performed | |||||
|---|---|---|---|---|---|
| Provider Characteristics | 0–2 (n = 534) |
3 (n = 837) |
4 (n = 705) |
All Inpatients (n = 2076) |
P Value* |
| Demographics | |||||
| Median age, y | 75 | 74 | 74 | 74 | .93 |
| Women, % | 53.0 | 51.7 | 49.1 | 51.2 | .36 |
| Race and ethnicity, % | .07 | ||||
| White, non-Hispanic | 91.8 | 89.1 | 90.5 | 90.3 | |
| Black, non-Hispanic | 6.2 | 8.1 | 8.2 | 7.7 | |
| Hispanic | 2.1 | 2.2 | 1.3 | 1.8 | |
| Other† | 0.0 | 0.6 | 0.0 | 0.2 | |
| Nursing home resident | 4.7 | 6.1 | 6.2 | 5.8 | .45 |
| Health insurance, % | .45 | ||||
| Health maintenance organization | 24.9 | 24.4 | 25.3 | 24.8 | |
| Fee for service | 70.0 | 72.5 | 70.6 | 71.2 | |
| Uninsured or unknown | 5.1 | 3.1 | 4.1 | 4.0 | |
| Comorbid conditions, % | |||||
| Neoplastic disease | 3.9 | 3.6 | 3.4 | 3.6 | .88 |
| Liver disease | 1.7 | 0.6 | 0.6 | 0.9 | .06 |
| Congestive heart failure | 17.4 | 19.2 | 21.3 | 19.5 | .23 |
| Cerebrovascular disease | 10.7 | 10.5 | 12.1 | 11.1 | .59 |
| Renal disease | 4.5 | 5.4 | 4.3 | 4.8 | .56 |
| Cognitive impairment‡ | 5.8 | 5.6 | 6.2 | 5.9 | .87 |
| History of coronary artery disease‡ | 26.6 | 27.4 | 28.8 | 27.7 | .67 |
| Chronic pulmonary disease‡ | 39.1 | 41.0 | 35.7 | 38.7 | .11 |
| Diabetes mellitus‡ | 21.4 | 25.3 | 26.1 | 24.6 | .13 |
| ≥1 of the above conditions | 73.8 | 75.8 | 72.8 | 74.2 | .40 |
| Physical examination findings, % | |||||
| Altered mental status | 5.4 | 5.7 | 5.4 | 5.5 | .95 |
| Temperature < 35°C or ≥40°C | 1.9 | 2.5 | 2.3 | 2.3 | .74 |
| Pulse ≥ 125 beats/min | 9.7 | 12.9 | 13.4 | 12.3 | .12 |
| Respiratory rate ≥ 30 breaths/min | 11.1 | 16.4 | 17.1 | 15.2 | .007 |
| Systolic BP < 90 mm Hg | 2.4 | 1.7 | 2.8 | 2.3 | .30 |
| Laboratory and radiographic findings, % | |||||
| Arterial pH < 7.35 | 14.3 | 13.9 | 10.6 | 13.0 | .54 |
| Blood urea nitrogen ≥ 30 mg/dL | 23.0 | 22.6 | 19.5 | 21.7 | .24 |
| Sodium < 130 mEq/L | 5.3 | 4.9 | 6.7 | 5.6 | .29 |
| Glucose ≥ 250 mg/dL | 8.1 | 7.6 | 7.4 | 7.7 | .90 |
| Hematocrit < 30% | 8.6 | 5.8 | 6.4 | 6.7 | .13 |
| Oxygen desaturation | 27.3 | 31.1 | 32.2 | 30.5 | .17 |
| Radiographic pleural effusion | 19.2 | 19.9 | 19.2 | 19.5 | .93 |
| PSI, % | .12 | ||||
| Class I | 9.2 | 7.4 | 6.7 | 7.6 | |
| Class II | 21.5 | 20.1 | 17.3 | 19.5 | |
| Class III | 24.7 | 24.1 | 24.4 | 24.4 | |
| Class IV | 33.5 | 36.6 | 41.7 | 37.5 | |
| Class V | 11.1 | 11.8 | 9.9 | 11.0 | |
| Treatments before presentation, % | |||||
| Home oxygen therapy | 9.9 | 10.4 | 8.1 | 9.5 | .28 |
| Oral or inhaled corticosteroid therapy | 18.2 | 14.8 | 14.8 | 15.7 | .18 |
| Antibiotic therapy in past 7 d | 19.7 | 16.0 | 11.6 | 15.5 | <.001 |
| Other Characteristics, % | |||||
| Suspected aspiration | 2.3 | 1.8 | 1.1 | 1.7 | .31 |
| Physician order limiting resuscitative efforts | 4.1 | 4.2 | 3.8 | 4.1 | .94 |
| Presentation at night or on a weekend | 45.7 | 47.0 | 50.5 | 47.8 | .20 |
| Provider Characteristics | |||||
| Gender (male), % | 78.7 | 83.6 | 84.7 | 82.7 | .08 |
| Year of medical school graduation, % | .61 | ||||
| ≥1990 | 37.9 | 37.7 | 33.8 | 36.4 | |
| 1980–1989 | 39.4 | 38.0 | 42.3 | 39.8 | |
| 1960–1979 | 22.8 | 24.3 | 24.0 | 23.8 | |
| No. of shifts worked per month, % | .90 | ||||
| ≥12 | 76.4 | 76.1 | 75.6 | 76.0 | |
| 5–11 | 15.4 | 16.9 | 17.0 | 16.5 | |
| 1–4 | 8.3 | 7.1 | 7.4 | 7.5 | |
| Emergency department director, % | 7.1 | 13.3 | 18.3 | 13.4 | <.001 |
| Site Characteristics | |||||
| Study intervention group,§ % | <.001 | ||||
| Low-intensity | 40.1 | 26.5 | 18.4 | 27.3 | |
| Moderate-intensity | 33.7 | 33.7 | 28.2 | 31.8 | |
| High-intensity | 26.2 | 39.8 | 53.3 | 40.9 | |
| Emergency department characteristics, % | |||||
| Urban location | 91.8 | 93.2 | 93.9 | 93.1 | .58 |
| Affiliated with a teaching hospital | 48.9 | 44.8 | 44.1 | 45.6 | .30 |
| Pneumonia pathway used | 64.4 | 64.5 | 70.1 | 66.4 | .09 |
| Pneumonia order form used | 31.1 | 33.1 | 37.2 | 34.0 | .12 |
| Have residents that treat patients | 32.2 | 29.0 | 23.1 | 27.8 | .009 |
BP = blood pressure; PSI = Pneumonia Severity Index.
We compared patient characteristics by the total number of processes of care performed using 2-sided chi-square tests for categoric variables and with Kruskal-Wallis tests for age. Comparisons of provider and site characteristics account for the clustering of patients within providers and emergency department sites. Calculations were made at the patient level for all characteristics and are based on the entire inpatient population (n = 2076) except for physical examination findings, laboratory and radiographic findings, and provider characteristics, for which denominators are based on available data. For these characteristics, data were missing for < 5% of patients except for arterial pH, for which data were available for 546 patients (26.3%).
Other races and ethnicities consist of Asian/Pacific Islanders, Native Americans or Alaskan Natives, and uncategorized.
Comorbid conditions not contained in the PSI.
Study sites were randomized to low-, moderate-, or high-intensity guideline implementation strategies.