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Dedier and colleagues¹ studied 1062 community-acquired pneumonia (CAP) hospitalizations and found no consistent relationship between treatment process (hours to first antibiotic administration, early blood culture collection before administration of antibiotics, and oxygenation assessment) and outcomes (inpatient death, clinical stability, and length of stay). The authors express concern about the use of process markers as measures of quality of care. They specifically mention the Centers for Medicare and Medicaid Services' effort "to increase the proportion of patients who receive antibiotics within 8 hours of arrival, and who have blood cultures performed before antibiotics are given."

As collaborators in the development of the Centers for Medicare and Medicaid Services National Pneumonia Project (NPP),² we welcome the opportunity to describe it and the rationale and clinical evidence behind its performance measures. The NPP uses the Medicare quality improvement review organizations (formerly known as PROs), working with physicians and hospital staff, to increase influenza . . . [Full Text of this Article]

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