• E A Halm, S J Atlas, L H Borowsky, T I Benzer, and D E Singer.
• Department of Health Policy, Mount Sinai School of Medicine, New York, NY 10029, USA.
• J Gen Intern Med. 1999 Nov 1;14(11):688-94.

ObjectiveTo assess physicians' response to implementation of an emergency department (ED) pneumonia practice guideline and determine if the guideline changed physicians' knowledge and attitudes about pneumonia care.DesignProspective intervention study with cross-sectional and longitudinal physician surveys.SettingAn urban, university teaching hospital ED.ParticipantsOne hundred forty physicians who were responsible for the triage of at least one of 166 patients presenting to the ED with community-acquired pneumonia.MeasurementsPhysician characteristics, attitudes about pneumonia care and guidelines, and ratings of guideline helpfulness and effects on patient care were obtained by self administered questionnaire before, during, and after a yearlong intervention.Main ResultsMore than 73% of the physicians reported the guideline as helpful and more than 94% wanted it to be continued in the future. Most reported that the guideline would decrease costs and improve quality without any increase in adverse outcomes. Two thirds said they were more likely to treat patients with pneumonia as outpatients in the future because of the guideline. Among the 58 physicians with matching preintervention and postintervention survey data, the guideline decreased the beliefs that "all patients> 65 years old with pneumonia should be admitted," from 52% to 14% ( p <. 001), and that "patients with pneumonia have a> 15% mortality rate," from 11% to 5% ( p <.007). The intervention did not significantly change general attitudes about practice guidelines. House officers rated the guideline as more helpful than attending physicians ( p <. 02).ConclusionsThis locally developed, actively implemented guideline was well regarded by physicians. Guidelines can change practice and also alter underlying knowledge and attitudes about disease management. They may be most useful to those with less experience.

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