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Research Findings for Consumers
A promising new model for doctors developed by U.S. and
Canadian researchers could lead to more patients being treated
for pneumonia in the comfort of their own homes as safely and as
effectively as if they were hospitalized, according to new
research supported by the Federal Government's Agency for Health
Care Policy and Research (AHCPR). The model—a clinical algorithm—can help doctors quickly and easily determine a patient's
risk level, which is essential for deciding where treatment
should take place and the type of therapy to be used.
Although pneumonia—a disease characterized by a bacterial
or viral infection of the lungs—can be deadly, research has
shown that the majority of patients are low-risk, meaning that
they are in little danger of dying from the disease or of
suffering serious consequences because of it.
Some patients already being treated in the hospital develop
pneumonia.However, this research addresses the vast majority of
pneumonia cases, patients not already hospitalized. About 4
million Americans a year develop this
"community-acquired" pneumonia and 600,000 of these, or
15 percent, are hospitalized.
Although about 85 percent of pneumonia cases currently are
treated outside the hospital, medical experts believe that an
even higher percentage are eligible for outpatient care, and
others could be hospitalized just for short periods. Treating
more pneumonia patients at home also could help lower the cost of
care. Inpatient treatment of pneumonia costs an estimated 10 to
15 times as much as outpatient care.
The problem is that doctors currently do not have
science-based criteria to guide their decisions for admitting
pneumonia patients. Part of the solution, researchers believe,
may lie in this new model, which helps physicians identify
pneumonia patients who do not need intensive treatment by
accurately estimating their progress, or prognosis, from basic
To ensure the accuracy of the algorithm, the researchers
tested it using data on thousands of pneumonia patients,
including roughly 2,300 individuals in Pittsburgh, Boston, and
Halifax, Nova Scotia, who were treated at home or in the
hospital. If the prediction model had been available to doctors
in those three cities, roughly a quarter to nearly one-third of
the hospitalized patients could have been assigned outpatient
care, and slightly over a tenth to almost one-fifth could have
been kept only briefly for observation instead of having a longer
What Patients Prefer
Most of the low-risk patients in the study who were surveyed,
including those hospitalized for initial treatment, said they
generally preferred home-based care. But the researchers found
that patients usually are not asked where and how they would like
their pneumonia to be treated. Of the doctors from the three-city
study who were surveyed, 83 percent said that they alone made the
decisions for outpatients, and 72 percent said they did so for
the inpatients. A number of factors weigh against home care, such
as the lack of a family caregiver, limited availability of home
nursing services, inability to drink fluids and take medication
by mouth, and certain severe medical conditions.
About the Study
These findings are from a recently completed, 5-year study of
variations and outcomes in pneumonia care. The research is part
of a series of studies on the quality, effectiveness, and
cost-effectiveness of current therapies for treating some of the
most common and costly medical conditions in the United States.
The project is supported by AHCPR—the U.S. Department of
Health and Human Services agency spearheading Federal efforts to
improve the quality of American medical care. The study was
directed by Wishwa N. Kapoor, M.D., M.P.H., from the University
of Pittsburgh School of Medicine.
Printed copies of Pneumonia: More Patients May Be Treated
at Home (AHCPR Pub. No. 97-R030), as well as a fact sheet
for clinicians, Pneumonia:
New Prediction Model Proves Promising (AHCPR Pub. No.
97-R031), are available by calling the AHCPR Publications
Clearinghouse at 800-358-9295. From outside the United States,
call (703) 437-2078.
AHCPR Publication No. 97-R030
Current as of January 1997