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. 2023 Dec 30;13(1):230.
doi: 10.3390/jcm13010230.

Practical Utility of a Clinical Pathway for Older Patients with Aspiration Pneumonia: A Single-Center Retrospective Observational Study

Taisuke Araki  1   2 , Yoshitaka Yamazaki  2 , Masanobu Kimoto  2 , Norihiko Goto  1   2 , Yuichi Ikuyama  1   2 , Yuko Takahashi  3 , Makoto Kosaka  2
Affiliations

Practical Utility of a Clinical Pathway for Older Patients with Aspiration Pneumonia: A Single-Center Retrospective Observational Study

Taisuke Araki et al. J Clin Med. .

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.

Keywords: aspiration pneumonia; clinical pathway; inverse probability of treatment weighting; older patients; prognosis; propensity score; propensity score matching.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
Schematic diagram and timeline of the clinical pathway used for older patients with aspiration pneumonia in this study. Abbreviations: OT, occupational therapist; PT, physical therapist; ST, speech therapist. Note: All interventions could be modified at the discretion of the attending physician.
Figure 2
Figure 2
Study flowchart. Abbreviations: CPW, clinical pathway; IPTW, inverse probability of treatment weighting; PSM, propensity score matching.
See this image and copyright information in PMC

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