Reducing Length of Stay for Veterans Hospitalized With Pneumonia

The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Read our disclaimer for details. Identifier: NCT01068548
Recruitment Status : Completed
First Posted : February 15, 2010
Results First Posted : November 17, 2014
Last Update Posted : April 28, 2015
Information provided by (Responsible Party):
VA Office of Research and Development

Brief Summary:
This is a pilot study to implement a computer based intervention to safely reduce length of hospital stay and time to conversion to oral antibiotics for patients with pneumonia.

Condition or disease Intervention/treatment Phase
Pneumonia Other: reminder Not Applicable

Detailed Description:

Pneumonia is the 3rd leading medical discharge diagnosis in the VA, and although significant attention has been focused improving pneumonia process of care measures less attention has been paid to resource use, specifically length of hospital stay (LOS). Based on our preliminary analyses LOS is considerably higher in the VA versus other non-federal hospitals. Major causes of this increased length of stay are delayed conversion from intravenous (IV) to oral therapy upon reaching clinical stability, and not discharging on the same day as the conversion to oral antibiotics. Therefore additional interventions are needed to decrease the LOS for veterans hospitalized with pneumonia in the VA system.

The long-term goal of this research is to develop sustainable approaches to reduce LOS and thereby improve efficiency of care in veterans admitted with pneumonia to VA Medical Centers through the implementation of computerized clinical stability reminders. Although prior research, including our own, has demonstrated moderate effectiveness of resource intense methods to implement this criteria (e.g., utilization management nurses) new, more effective and less resource intense, strategies are needed to accomplish this long-term goal. The design of the computerized clinical stability reminder, the likely range in magnitude of response to implementation of the intervention, logistics of data collection, data management, and development of study instruments are needed prior to commencement of a more definitive, multi-center study. Hence, we are seeking funding to conduct the necessary pilot work needed to successfully design and implement a large multi-center randomized intervention study to reduce LOS for veterans with pneumonia.

Our objectives include: 1) Develop and perform a local pilot implementation of an inpatient clinical reminder within Computerized Patient Record System to identify when veterans hospitalized with pneumonia are clinically stable and ready for conversion form IV to oral antibiotic therapy and hospital discharge. 2) Test measures of the constructs of the Theory of Planned Behavior (TPB) in VA medicine ward physicians and determine if they correlate with intention and discharge behavior. 3) Establish a collaborative of VA Medical Centers for the purpose of developing a larger scale implementation study to use evidence-based criteria to reduce LOS for patients hospitalized with pneumonia. 4) Prepare a VA HSR&D IIR grant proposal for a cluster randomized controlled trial of a clinical reminder intervention to reduce length of hospital stay among veterans hospitalized with pneumonia.

The proposed pilot study will develop and implement a computerized-based inpatient clinical reminder to assist physicians with appropriate conversion from IV to oral antibiotics and discharge on the same day for veterans hospitalized with pneumonia. In addition to creating and implementing the clinical reminder at single tertiary care VA teaching hospital, we will examine physician attitudes and potential barriers/facilitators to the introduction of inpatient clinical reminders using the theoretical model of TPB. We will also assemble a cohort of VA medical centers with investigators and chiefs of medical staff willing to participate in a multi-center randomized control trial of this intervention. The results from this pilot study will be used to plan a larger, more definitive multi-center trial of this inpatient clinical reminder with the goal of significantly reducing LOS for veterans hospitalized with pneumonia in the VA health care system.

Study Type : Interventional  (Clinical Trial)
Actual Enrollment : 129 participants
Allocation: Non-Randomized
Intervention Model: Single Group Assignment
Masking: None (Open Label)
Primary Purpose: Health Services Research
Official Title: Reducing Length of Stay for Veterans Hospitalized With Pneumonia
Study Start Date : February 2011
Actual Primary Completion Date : September 2011
Actual Study Completion Date : November 2011

Resource links provided by the National Library of Medicine

MedlinePlus related topics: Pneumonia
U.S. FDA Resources

Arm Intervention/treatment
No Intervention: Arm 1
pre-implementation of computer based intervention
Experimental: Arm 2
post-implementation of computer based length of stay clinical reminder
Other: reminder
computer based reminder to change patients from IV to oral antibiotics based on evidence based clinical practice guidelines

Primary Outcome Measures :
  1. Length of Hospital Stay [ Time Frame: 1 month ]

Secondary Outcome Measures :
  1. Time to Change to Oral Antibiotics [ Time Frame: 1 month ]

Information from the National Library of Medicine

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Ages Eligible for Study:   18 Years and older   (Adult, Senior)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No

Inclusion Criteria:

  • Patient hospitalized with outpatient-acquired pneumonia at South Texas Veterans Health Care System during study period.

Exclusion Criteria:

Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its identifier (NCT number): NCT01068548

United States, Texas
South Texas Health Care System, San Antonio, TX
San Antonio, Texas, United States, 78229
Sponsors and Collaborators
VA Office of Research and Development
Principal Investigator: Eric Michael Mortensen, MD MSc BA South Texas Health Care System, San Antonio, TX

Responsible Party: VA Office of Research and Development Identifier: NCT01068548     History of Changes
Other Study ID Numbers: PPO 09-288
First Posted: February 15, 2010    Key Record Dates
Results First Posted: November 17, 2014
Last Update Posted: April 28, 2015
Last Verified: August 2014

Additional relevant MeSH terms:
Lung Diseases
Respiratory Tract Diseases
Respiratory Tract Infections