Accepted for Publication: March 29, 2019.
Corresponding Author: Harin Karunajeewa, MBBS, PhD, General Internal Medicine Unit, Western Health, The University of Melbourne, Melbourne, Australia (harin.karunajeewa@wh.org.au).
Published Online: July 8, 2019. doi:10.1001/jamainternmed.2019.1438
Author Contributions: Ms Lloyd and Dr Karunajeewa had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.
Concept and design: Lloyd, Karahalios, Janus, Skinner, Haines, Shackell, Karunajeewa.
Acquisition, analysis, or interpretation of data: Lloyd, Karahalios, Janus, Skinner, Haines, De Silva, Lowe, Ko, Desmond, Karunajeewa.
Drafting of the manuscript: Lloyd, Janus, Skinner, Karunajeewa.
Critical revision of the manuscript for important intellectual content: All authors.
Statistical analysis: Lloyd, Karahalios, Haines, De Silva, Karunajeewa.
Obtained funding: Janus, Skinner, Haines, Karunajeewa.
Administrative, technical, or material support: Lloyd, Janus, Skinner, Lowe, Shackell, Ko, Desmond, Karunajeewa.
Supervision: Lloyd, Janus, Skinner, Karunajeewa.
Conflict of Interest Disclosures: Ms Lloyd reported personal fees from Australian Government Research Training Scheme during the conduct of the study. Ms Lloyd and Drs Janus, Skinner, Shackell, Ko, and Karunajeewa reported receiving grants from HCF Research Foundation during the conduct of the study. No other disclosures were reported.
Funding/Support: This study received funding from grant number EJWH2015163 from the HCF Research Foundation. Western Health, the University of Melbourne, and Monash University provided salary support to the investigators. Dr Karunajeewa was supported by an Australian National Health and Medical Research Council Career Development Fellowship. Ms Lloyd was supported by an Australian Government Research Training Scheme Scholarship.
Role of the Funder/Sponsor: The funding sources had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and the decision to submit the manuscript for publication.
Group Information: The members of the Improving Evidence-Based Treatment Gaps and Outcomes in Community-Acquired Pneumonia (IMPROVE-GAP) Implementation Team at Western Health are as follows: Monica Turczyniak, BPhysio, Department of Physiotherapy, Western Health, Melbourne; Kamya Kameshwar, MBBS, Department of General Internal Medicine, Western Health, Melbourne; Ben Stevenson, MBBS, Department of General Internal Medicine, Western Health, Melbourne; Parul Bali, MBBS, Department of General Internal Medicine, Western Health, Melbourne; Elena Gerstman, BPhysio, Department of Physiotherapy, Western Health, Melbourne; and Kirsty May, BPhysio (Hons), Department of Physiotherapy, Western Health, Melbourne.
Data Sharing Statement: See Supplement 3.
Additional Contributions: The Western Health Physiotherapy Team—Cassandra Raios, BPhysio, Melanie Paykel, DPT, Joshua Warren, Sarah Miller, DPT, Codey Lyon, BPhysio, Kate Ryan, BPhysio, Emily Simek, BPhysio, Diana Truong, MPhysio, and Rachel Whitford, DPT, Department of Physiotherapy, Western Health, Melbourne—delivered the early mobilization interventions. Anne-Maree Kelly, MBBS, Joseph Epstein Centre for Emergency Medicine Research at Western Health, Melbourne, May-Lea Ong, MD, Department of General Internal Medicine, Western Health, Melbourne; and Clarice Tang, DPT, Department of Physiotherapy, Western Health, Melbourne, provided advice on the development of the project. Vanessa Carter, MND, and Allison Lauder, MND, Department of Nutrition, Western Health, Melbourne; provided advice on the design of the nutrition intervention. Julie Simpson, PhD, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, provided advice regarding the statistical analysis plan. Ms Turczyniak, Mrs Gerstman, Ms May, Dr Kameshwar, Dr Bali, Dr Stevenson, Ms Raios, Mr Warren, Dr Paykel, Dr Miller, Ms Lyon, Ms Ryan, Ms Simek, Ms Truong, and Dr Whitford received compensation in the form of clinician salary support for delivery of the CAP Service interventions.
3.Millett
ER, Quint
JK, Smeeth
L, Daniel
RM, Thomas
SL. Incidence of community-acquired lower respiratory tract infections and pneumonia among older adults in the United Kingdom: a population-based study.
PLoS One. 2013;8(9):e75131. doi:
10.1371/journal.pone.0075131PubMedGoogle ScholarCrossref 8.Weir
DL, Majumdar
SR, McAlister
FA, Marrie
TJ, Eurich
DT. The impact of multimorbidity on short-term events in patients with community-acquired pneumonia: prospective cohort study.
Clin Microbiol Infect. 2015;21(3):264.e7-264.e13. doi:
10.1016/j.cmi.2014.11.002PubMedGoogle ScholarCrossref 9.Ewig
S, Birkner
N, Strauss
R,
et al. New perspectives on community-acquired pneumonia in 388 406 patients: results from a nationwide mandatory performance measurement programme in healthcare quality.
Thorax. 2009;64(12):1062-1069. doi:
10.1136/thx.2008.109785PubMedGoogle ScholarCrossref 12.Ramirez
JA, Vargas
S, Ritter
GW,
et al. Early switch from intravenous to oral antibiotics and early hospital discharge: a prospective observational study of 200 consecutive patients with community-acquired pneumonia.
Arch Intern Med. 1999;159(20):2449-2454. doi:
10.1001/archinte.159.20.2449PubMedGoogle ScholarCrossref 13.Carratalà
J, Garcia-Vidal
C, Ortega
L,
et al. Effect of a 3-step critical pathway to reduce duration of intravenous antibiotic therapy and length of stay in community-acquired pneumonia: a randomized controlled trial.
Arch Intern Med. 2012;172(12):922-928. doi:
10.1001/archinternmed.2012.1690PubMedGoogle ScholarCrossref 15.Torres
A, Sibila
O, Ferrer
M,
et al. Effect of corticosteroids on treatment failure among hospitalized patients with severe community-acquired pneumonia and high inflammatory response: a randomized clinical trial.
JAMA. 2015;313(7):677-686. doi:
10.1001/jama.2015.88PubMedGoogle ScholarCrossref 17.Siemieniuk
RA, Meade
MO, Alonso-Coello
P,
et al. Corticosteroid therapy for patients hospitalized with community-acquired pneumonia: a systematic review and meta-analysis.
Ann Intern Med. 2015;163(7):519-528. doi:
10.7326/M15-0715PubMedGoogle ScholarCrossref 20.Briel
M, Spoorenberg
SMC, Snijders
D,
et al; Ovidius Study Group; Capisce Study Group; STEP Study Group. Corticosteroids in patients hospitalized with community-acquired pneumonia: systematic review and individual patient data metaanalysis.
Clin Infect Dis. 2018;66(3):346-354. doi:
10.1093/cid/cix801PubMedGoogle ScholarCrossref 23.Skinner
EH, Lloyd
M, Janus
E,
et al. The IMPROVE-GAP Trial aiming to improve evidence-based management of community-acquired pneumonia: study protocol for a stepped-wedge randomised controlled trial.
Trials. 2018;19(1):88. doi:
10.1186/s13063-017-2407-4PubMedGoogle ScholarCrossref 24.Curran
GM, Bauer
M, Mittman
B, Pyne
JM, Stetler
C. Effectiveness-implementation hybrid designs: combining elements of clinical effectiveness and implementation research to enhance public health impact.
Med Care. 2012;50(3):217-226. doi:
10.1097/MLR.0b013e3182408812PubMedGoogle ScholarCrossref 26.Charles
PG, Wolfe
R, Whitby
M,
et al; Australian Community-Acquired Pneumonia Study Collaboration. SMART-COP: a tool for predicting the need for intensive respiratory or vasopressor support in community-acquired pneumonia.
Clin Infect Dis. 2008;47(3):375-384. doi:
10.1086/589754PubMedGoogle ScholarCrossref 28.Berney
S, Haines
K, Skinner
EH, Denehy
L. Safety and feasibility of an exercise prescription approach to rehabilitation across the continuum of care for survivors of critical illness.
Phys Ther. 2012;92(12):1524-1535. doi:
10.2522/ptj.20110406PubMedGoogle ScholarCrossref 29.Chêne
G, Morlat
P, Leport
C,
et al. Intention-to-treat vs on-treatment analyses of clinical trial data: experience from a study of pyrimethamine in the primary prophylaxis of toxoplasmosis in HIV-infected patients: ANRS 005/ACTG 154 Trial Group.
Control Clin Trials. 1998;19(3):233-248. doi:
10.1016/S0197-2456(97)00145-1PubMedGoogle ScholarCrossref 30.Haines
TP, O’Brien
L, Mitchell
D,
et al. Study protocol for two randomized controlled trials examining the effectiveness and safety of current weekend allied health services and a new stakeholder-driven model for acute medical/surgical patients versus no weekend allied health services.
Trials. 2015;16:133. doi:
10.1186/s13063-015-0619-zPubMedGoogle ScholarCrossref 31.Hill
AM, McPhail
SM, Waldron
N,
et al. Fall rates in hospital rehabilitation units after individualised patient and staff education programmes: a pragmatic, stepped-wedge, cluster-randomised controlled trial.
Lancet. 2015;385(9987):2592-2599. doi:
10.1016/S0140-6736(14)61945-0PubMedGoogle ScholarCrossref 34.Horita
N, Otsuka
T, Haranaga
S,
et al. Adjunctive systemic corticosteroids for hospitalized community-acquired pneumonia: systematic review and meta-analysis 2015 update.
Sci Rep. 2015;5:14061. doi:
10.1038/srep14061PubMedGoogle ScholarCrossref