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Media Advisory Date: January 23, 1997
The Federal Agency for Health Care Policy and Research (AHCPR)
a simple and accurate method to predict which patients with
pneumonia may be
treated at home rather than in a hospital. The prediction
model used to help doctors assess the need for
hospitalization—also could help
reduce the over $4 billion spent annually for inpatient care.
This model is
described in the January 23 issue of the New England Journal
About 600,000, or 15 percent, of the 4 million Americans who
pneumonia each year are hospitalized. Because of the lack of
admission criteria and the tendency to overestimate the risk of
low-risk patients who could be safely treated outside the
hospital are admitted
for inpatient care. Hospitalization costs for this disease are
estimated to be
10 to 15 times higher than outpatient therapy.
The prediction method is intended to help doctors identify more
easily which pneumonia patients do not require intensive
made from a prospective study by the researchers of roughly 2,300
Pittsburgh, Pa., Boston, Mass., and Halifax, Nova Scotia, who
were treated for
pneumonia at home or in the hospital, suggest that 26 to 31
percent of those
hospitalized could have been treated on an outpatient basis, had
the model been
used. Another 13 to 19 percent of the inpatients could have been
only briefly for observation.
While the researchers caution there may be other factors
that should be
considered before assigning a patient to outpatient care,
preferences, the ability to drink fluids and take medication by
of a caregiver or certain severe medical conditions, they
conclude that they
have enough preliminary evidence to show their prediction method
hospitalizations without jeopardizing patient health and quality
of care. In
addition, it may assure that high-risk patients are appropriately
The findings, which were reported by Michael J. Fine, M.D.,
professor of medicine at the University of Pittsburgh School of
co-investigators from the University of Pittsburgh, Harvard
Medical School and
Dalhousie University, are from the AHCPR-funded study on the
Variations and Outcomes for Community-Acquired Pneumonia, which
was directed by
Wishwa N. Kapoor, M.D., M.P.H., also of the University of
Pittsburgh. The New
England Journal of Medicine
article is entitled, "A Prediction Rule To Identify
With Community-Acquired Pneumonia."
AHCPR's pneumonia study is part of a major effort to
uncertainty and improve treatment effectiveness. The findings
in two fact sheets: What's New for Clinicians: Pneumonia,
Model Proves Promising and What's New for Consumers:
Patients May Be Treated At Home. Both are available from
Publications Clearinghouse, P.O. Box 8547, Silver Spring, MD,
800-358-9295. A copy of this study's final report
Publication No. 97-N009) can be obtained from the Clearinghouse
(AHCPR Pub. No.
97-N009) or the National Technical Information Service, 5285 Port
Springfield, VA, 22161, or call (703) 487-4650. Ask for accession
For additional information, contact AHCPR Public Affairs: Karen Carp, (301) 427-1858; Karen Migdail, (301) 427-1855 ; Salina
Prasad, (301) 427-1864. To arrange interviews with Drs. Fine or Kapoor, please
contact Amy Kemp,
University of Pittsburgh Medical Center News Bureau, (412)
arrange interviews with Daniel E. Singer, M.D., and Christopher M.
please contact Michelle Marcella, Massachusetts General Hospital
Office, (617) 724-2755.