Community-Acquired Pneumonia Clinical Decision Support Implementation Toolkit

Community-acquired pneumonia is the eighth leading cause of death in the United States, according to the Centers for Disease Control and Prevention. Approximately 6 million cases are reported annually, resulting in an estimated 4.2 million ambulatory care visits, with adults age 65 and older most vulnerable.

This toolkit is a resource to help clinicians and clinical informaticians in primary care and other ambulatory settings implement and adopt the CAP clinical decision support (CDS) alert for the management of community-acquired pneumonia.

The CAP CDS alert is based on the CURB-65 tool that assesses CAP severity and recommends site of care (e.g., hospital or home) based on five clinical factors: patient confusion, uremia, elevated respiratory rate, low blood pressure, and age 65 years or older. Uremia is used in emergency departments that have ready laboratory access, but primary care practices use only the four other risk factors. Scores from 0 to 4 or 5 determine the appropriate site of care, with the higher score indicating higher severity of illness.

Potential users of the toolkit include clinicians (e.g., physicians, advanced practice clinicians, nurses), administrators (e.g., medical directors, medical information officers, information technology staff, and practice managers) and those developing and implementing the CDS (e.g., informaticists, information technology staff).

Toolkit Materials

The toolkit consists of:

• Community-Acquired Pneumonia Clinical Decision Support Implementation Toolkit Handbook (PDF, 1 MB) on how to use the toolkit.
• Prototype of the CDS alert for electronic health records (vendor-agnostic) for the ED (PDF, 190 KB) and a short pamphlet on use of the alert in the ED (PDF, 293 KB).
• Prototype of the CDS alert  for electronic health records (vendor-agnostic) for primary care (PDF, 190 KB) and a short pamphlet on use of the alert in primary care (PDF, 293 KB).
• Workflow diagrams of how the CAP alert can be integrated into the ED (PDF, 308.93 KB) or primary care workflows (PDF, 327.84 KB).
• Training slide decks for the ED and primary care setting on how and when to use the CAP alert in the electronic health record and how to incorporate it into the workflow:
  • Emergency Department Setting [Powerpoint, 1.79 MB; HTML].
  • Primary Care Setting [Powerpoint, 397.5 KB; HTML].

About the Toolkit Development

This toolkit was developed by NORC at the University of Chicago and Yale University as part of an initiative by AHRQ to fund studies on how to improve patient safety in ambulatory care settings. This particular toolkit aims to improve ambulatory care safety through development and implementation of clinical decision support alerts for CAP that would help clinicians determine the most appropriate site of care for patients with CAP.

• Final Report (PDF, 2.85 MB).