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Abstract：
Introduction: Clinical pathways (CPWs) are patient management tools based on a standardized treatment plan aimed at improving quality of care. This study aimed to investigate whether CPW-guided treatment has a favorable impact on the outcomes of hospitalized older patients with aspiration pneumonia. Method: This retrospective study included patients with aspiration pneumonia, aged ≥ 65 years, and hospitalized at a community hospital in Japan. CPW implementation was arbitrarily determined by the attending physician upon admission. Outcomes were compared according to with or without the CPW (CPW-group and non-CPW groups). Propensity score (PS)-based analyses were used to control for confounding factors. Logistic regression analyses were conducted to evaluate the impact of CPW on the clinical course and outcomes. Results: Of 596 included patients, 167 (28%) received the CPW-guided treatment. The mortality rate was 16.4%. In multivariable model, CPW implementation did not increase the risk for total and 30-day mortality, and resulted in shorter antibiotic therapy duration (≤9 days) (PS matching (PSM): odds ratio (OR) 0.50, p = 0.001; inverse provability of treatment weighting (IPTW): OR 0.48, p < 0.001) and length of hospital stay (≤21 days) (PSM: OR 0.67, p = 0.05; IPTW: OR 0.66, p = 0.03). Conclusions: This study support CPW utility in this population.
摘要：
简介：临床路径（CPW）是基于标准化治疗计划的患者管理工具，旨在提高护理质量。本研究旨在调查CPW指导治疗是否对住院老年吸入性肺炎患者的预后产生有利影响。方法:本研究纳入吸入性肺炎患者,年龄≥65岁，在日本一家社区医院住院。CPW的实施由主治医师在入院时任意确定。根据有或没有CPW（CPW组和非CPW组）比较结果。使用基于倾向评分(PS)的分析来控制混杂因素。进行Logistic回归分析以评估CPW对临床过程和结果的影响。结果：在596名患者中，167人（28%）接受了CPW指导治疗。死亡率为16.4%。在多变量模型中，实施CPW并没有增加总死亡率和30天死亡率的风险，并导致抗生素治疗持续时间更短(≤9天)(PS匹配(PSM):比值比(OR)0.50,p=0.001;治疗权重逆证明(IPTW):OR0.48,p<0.001)和住院时间(≤21天)(PSM:OR0.67,p=0.05;IPTW:OR0.66,p=0.03).结论：本研究支持CPW在该人群中的应用。
