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New Predictive Tool Could Reduce Hospital Admissions for Nursing Home Residents with Lower Respiratory Infections

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Press Release Date: November 20, 2001

Researchers in Missouri have designed a new tool that helps identify nursing home residents at relatively low risk for death from lower respiratory infection (LRI), which means patients may be treated safely without transferring them to a hospital. LRIs, primarily pneumonia, are the leading causes of hospitalization and death among nursing home residents. The study was partly funded by the Agency for Healthcare Research and Quality (AHRQ), and published in the November 21 issue of the Journal of the American Medical Association.

The new tool helps clinicians determine the severity of the illness and the risk of death, which can help them choose the location for treatment more quickly. Residents at low risk of dying may be managed best in the nursing home, which may prevent complications or discomfort that can occur from a hospital admission.

David R. Mehr, M.D., M.S., at the University of Missouri-Columbia School of Medicine, Ellen F. Binder, M.D., at Washington University School of Medicine in St. Louis, and their colleagues built on the work of earlier research funded by AHRQ, conducted by the Patient Outcomes Research Team (PORT) on Community-Acquired Pneumonia. The PORT developed and validated the Pneumonia Severity Index (PSI), which is used to identify pneumonia patients living in the community who can be treated safely at home. Because the PSI assigns higher risk based on age and other variables common to elderly people, it predisposes most nursing home residents with respiratory conditions to hospitalization, whether or not their condition actually warrants it. To make the new tool more sensitive to residents of nursing facilities, the researchers gave more weight to variables such as activities of daily living (ADLs), mood decline, and markers of poor nutritional status.

The researchers caution that since all facilities in the study were in central or eastern Missouri, the tool will have to be validated in other states, where factors affecting mortality may be different. Details can be found in "Predicting mortality from lower respiratory infection in nursing home residents: the Missouri LRI Study," JAMA, November 21, 2001, p. 2427-2436.

Editor's Note: For interviews with Dr. Mehr, please contact Monica R. Moore, Media Relations Coordinator, University of Missouri Health Care, at (573) 882-5663.

For more information, please contact AHRQ Public Affairs: Karen Carp, (301) 427-1858 ( or Karen Migdail, (301) 427-1855 (


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