Extending the Nurse Practitioner Concurrent Intervention Model to Community-Acquired Pneumonia and Chronic Obstructive Pulmonary Disease

Several professional and governmental organizations have written guidelines for treatment of community acquired pneumonia (CAP) that can improve quality of care and reduce mortality for patients with CAP, especially those from the heavily affected Medicare population. In this article, the authors present a study designed to evaluate whether quality improvement (QI) cycles performed by nurse practitioners (NPs) can improve CAP guideline compliance. The study also evaluates whether NP acceleration of certain care protocols can decrease cost of care and whether this system, designed for patients with CAP, is also applicable to patients with chronic obstructive pulmonary disease (COPD). Pulmonary-trained NPs were assigned to help physicians comply with CAP guidelines in treating patients at Hackensack University Medical Center in New Jersey. Interventions to decrease cost of care included early switch therapy, in which antibiotics are changed from intravenous (IV) to oral administration, and early discharge. Researchers then adapted early switch and early discharge guidelines to COPD patients. These interventions resulted in significant reductions in length of stay and substantial cost savings. Nurse Practitioner use resulted in guideline compliance at a rate of over 90 percent of the time for almost all measures, substantially higher than the national median rates. This before-and-after study provides strong evidence of the effectiveness in employing NPs for guideline compliance.