Dr Ikai is now with the Department of Healthcare Economics and Quality Management, Kyoto University School of Public Health, Kyoto, Japan. Morimoto is now with the Center for Medical Education, Kyoto University, Kyoto, Japan. Dr Shimbo is now with the Department of Clinical Research and Informatics, Research Institute, International Medical Center of Japan, Tokyo, Japan.
Impact of postgraduate education on physician practice for community-acquired pneumonia
Article first published online: 5 JAN 2011
© 2011 Blackwell Publishing Ltd
Journal of Evaluation in Clinical Practice
Volume 18, Issue 2, pages 389–395, April 2012
How to Cite
Ikai, H., Morimoto, T., Shimbo, T., Imanaka, Y. and Koike, K. (2012), Impact of postgraduate education on physician practice for community-acquired pneumonia. Journal of Evaluation in Clinical Practice, 18: 389–395. doi: 10.1111/j.1365-2753.2010.01594.x
Grant Support: This study was supported in part by a grant-in-aid (health technology assessment) from the Ministry of Health, Labor, and Welfare, Japan.
- Issue published online: 5 MAR 2012
- Article first published online: 5 JAN 2011
- Accepted for publication: 10 September 2010
- community-acquired pneumonia;
- length of stay;
- longitudinal studies;
- physician's practice patterns;
- professional education
Background Clinical practice guidelines on community-acquired pneumonia (CAP) are widely recognized by hospitals in Japan; however, little is known about the effect of postgraduate education on physicians' adherence to the guidelines or on patient outcomes.
Method We conducted a chart review of inpatient CAP cases at a single teaching hospital in Japan from 2003 to 2005, during which the educational programme for residents was gradually reinforced by the introduction of multifaceted education and training in the management of infectious diseases. To assess the effects of this educational programme, we measured process indicators such as usage of diagnostic tests, choice of antibiotics, and clinical outcomes, including length of antibiotic treatment, length of stay, and mortality.
Results Several improvements were observed after educational intervention: (1) more frequent blood, sputum cultures, and Gram stain tests; (2) less frequent use of broad-spectrum antibiotics as the initial empiric therapy (from 50% to 12%) and on hospital day 5 (from 66.7% to 10%); and (3) median length of stay was shorter after intervention (16.5 days to 13 days).
Conclusions Our findings suggest that multifaceted educational intervention for residents focused on diagnostic efforts, including Gram stain and cultures, choice of antibiotics with the appropriate spectrum, and de-escalation of antibiotics, can increase adherence to CAP guidelines as well as improve clinical outcomes.