Program reduces hospitalizations and costs for nursing home residents with pneumonia

A program that includes having chest x-rays performed in the nursing home reduced the number of nursing home residents hospitalized because of pneumonia and other lower respiratory tract infections, according to a study in the June 7 issue of JAMA.

Pneumonia and other lower respiratory tract infections are common among residents of nursing homes. These infections are among the most frequent reasons for transferring residents to a hospital, according to background information in the article. Hospitalization can lead to a reduction in quality of life, a decline in functional status, falls, and other hazards. The economic costs associated with such hospital transfers are substantial. Given the potential hazards to residents and the burden on the health care health system, a strategy for treating residents with pneumonia on-site in the nursing home may be beneficial. However, the effectiveness of providing on-site care has been uncertain.

Mark Loeb, M.D., M.Sc., of McMaster University, Hamilton, Ontario, Canada, and colleagues developed a clinical pathway, or program, for treating nursing home residents with pneumonia or other lower respiratory tract infections on-site in the nursing home to determine if the program would reduce hospitalizations and health care costs. The randomized trial included 680 residents aged 65 years or older, who met a standardized definition of lower respiratory tract infection, in 22 nursing homes in Hamilton, Ontario, Canada. The residents received either usual care or treatment according to the program that was devised, which included use of oral antimicrobials, portable chest radiographs, oxygen saturation monitoring, rehydration, and close monitoring by a research nurse.

Thirty-four residents (10 percent) of 327 residents in the clinical pathway group were hospitalized compared with 76 (22 percent) of 353 residents in the usual care group. Adjusting for the clustering of residents in nursing homes, the weighted average admission rate was 8 percent in the clinical pathway group vs. 20 percent in the usual care group, with an average difference of 12 percent. The average number of hospital days per resident was 0.79 in the clinical pathway group vs. 1.74 in the usual care group, with an average difference of 0.95 days per resident.

The death rates in both study groups were similar. There were 24 deaths (8 percent) among residents enrolled in the clinical pathway group and 32 deaths (9 percent) among residents in the usual care group. There were no significant differences in changes in health-related quality of life or functional status measures. The clinical pathway resulted in an overall cost savings of U.S. $1,016 per resident treated.

"These data have important implications for the delivery of health care services for both long-term care facilities and acute care hospitals. Treating nursing home residents with pneumonia with the clinical pathway can reduce the burden to emergency departments and inpatient hospital units, particularly during influenza season, when many nursing home residents with pneumonia are frequently sent to the hospital," the authors write.

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(JAMA. 2006;295:2503-2510. Available pre-embargo to the media at www.jamamedia.org)

Editor's Note: For financial disclosure and funding/support information, please see the JAMA article.


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