The HCAP Gap: Differences Between Physicians' Self‐Reported Practice Patterns and Published Guidelines for Treatment of Health Care‐Associated Pneumonia

1University of California, San Diego, San Diego, CA
2Emory University, Atlanta, GA
3University of California, San Francisco, San Francisco, CA
4University of Michigan, Ann Arbor, MI
5Columbia University, New York, NY

Meeting: Hospital Medicine 2009, May 14-17, Chicago, Ill.

Abstract number: 90


Health care‐associated pneumonia (HCAP) is prevalent among hospitalized patients. In contrast to community‐acquired pneumonia (CAP), patients with HCAP are at increased risk for multidrug‐resistant organisms such as methicillin‐resfstant Staphylococcus aureus (MRSA) and Pseudomonas aeruginosa. Appropriate initial antibiotic therapy for patients with pneumonia is associated with reduced mortality, and published guidelines for both CAP and HCAP exist to guide therapy. This study assessed physicians' self‐reported prescribing patterns for patients with pneumonia, as well as their knowledge of and attitudes toward published guidelines.


An online survey was distributed at 4 academic medical centers. Physicians in specialties most likely to care for pneumonia patients were solicited, including hospital medicine faculty, internal medicine residents, emergency medicine faculty and residents, and pulmonary/critical care or anesthesia/critical care faculty and fellows. The survey consisted of 9 hypothetical pneumonia cases (7 HCAP, 2 CAP) and required that respondents choose an initial treatment regimen from a representative list of antibiotics used for both CAP and HCAP. Respondents could select multiple drugs, if appropriate, to allow for combination therapy. Answers were considered to be correct if the antibiotic regimen chosen was consistent with published guidelines. In addition, physicians rated their knowledge of current guidelines, as well as their level of agreement with guideline recommendations.


Surveys were sent to 1313 physicians, with a response rate of 65% (n = 855). Respondents included physicians in the following categories: hospital medicine/internal medicine 60%, emergency medicine 25%, and pulmonary/critical care 13%. Partial re‐sponders were excluded. Respondents selected guideline‐concordant antibiotic regimens 9% of the time for HCAP (range: 6%‐12%), as compared with 78% for CAP (range: 77%–79%). Despite their poor performance, 71% of the respondents stated that they were aware of published guidelines, and 79% stated that they agreed with and practiced according to the guidelines. Subgroup analysis revealed statistically significant differences in the mean number of correct answers based on specialty, level of training, and level of awareness of or agreement with published guidelines. Because mean scores for HCAP were extremely low (mean = 0.63 correct answers out of 7), differences in performance between groups were too small to be meaningful.


Physicians believe that they are aware of, agree with, and practice according to published guidelines for HCAP; however, they frequently chose initial antibiotic therapy that was inconsistent with guideline recommendations, The gap between perception and performance suggests the need for further investigation to target better ways of translating guidelines into practice, which may ultimately improve patient outcomes.

Author Disclosure:

G. Seymann, none; L. Difrancesco, none; B. Sharpe, none; J. Rohde, none; T. Dam, none.

To cite this abstract:

Seymann G, Francesco L, Sharpe B, Rohde J, Dam T. The HCAP Gap: Differences Between Physicians' Self‐Reported Practice Patterns and Published Guidelines for Treatment of Health Care‐Associated Pneumonia. Abstract published at Hospital Medicine 2009, May 14-17, Chicago, Ill. Abstract 90. Journal of Hospital Medicine. 2009; 4 (suppl 1). Accessed March 28, 2020.

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