Background: Although processes of care are common proxies for health care quality, their associations with medical outcomes remain uncertain.

Methods: For 2076 patients hospitalised with pneumonia from 32 emergency departments, we used multilevel logistic regression modelling to assess independent associations between patient outcomes and the performance of 4 individual processes of care (assessment of oxygenation, blood cultures, and rapid initiation (less than 4 hours) and appropriate selection of antibiotic therapy) and the cumulative number of processes of care performed.

Results: Overall, 141 patients (6.8%) died.  Mortality was 0.3% to 1.7% lower for patients who had each of the individual processes of care performed (P greater than 0.13 for each comparison); mortality was 7.5% for patients who had 0 to 2 processes of care, 7.2% for those with 3 processes of care and 5.8% for those with all 4 processes of care performed (P = 0.39).  Mortality was not significantly associated with either individual or cumulative process measures in multivariable models.

Conclusions: Neither the individual processes of care nor the cumulative number performed is associated with short-term mortality for pneumonia.