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Outcomes/Effectiveness Research

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Researchers present recent findings from the pneumonia PORT on hospital length of stay, symptoms, and outcomes

Over 1 million individuals are hospitalized for pneumonia each year in the United States. In 1994 alone, hospital costs for treating pneumonia were more than $9 billion. However, hospitals vary widely in how long they keep pneumonia patients in the hospital, and they are under pressure to reduce hospital stays for this condition.

The Pneumonia Patient Outcomes Research Team (PORT), led by Wishwa N. Kapoor, M.D., M.P.H., of the University of Pittsburgh, and supported by the Agency for Healthcare Research and Quality (HS06468), recently published two studies. The first study looks at the relationship between length of hospital stay and costs of care for patients with community-acquired pneumonia. In the second study, the researchers compare symptoms and outcomes for patients who have bacteremic and nonbacteremic pneumonia. The two studies are summarized here.

Fine, M.J., Pratt, H.M., Obrosky, D.S., and others. (2000). "Relation between length of hospital stay and costs of care for patients with community-acquired pneumonia." American Journal of Medicine 109, pp. 378-385.

The findings from this study suggest that hospitals probably could reduce pneumonia hospital stays by 1 day without adversely affecting patient health. This reduced stay would result in a mean savings of $680 per patient, with the majority of the savings ($495) attributable to room costs, according to the researchers. They estimated the daily medical care costs of 982 adults hospitalized with community-acquired pneumonia at a community hospital and two university teaching hospitals.

The median length of hospital stay was 7 days for all patients and ranged from 6 days at hospital C to 8 days at hospital A. The pattern of daily costs was similar for all three study hospitals, and only one hospital (B) had substantially higher daily costs (for room, pharmacy and IV solutions, and lab tests and procedures) than the other two.

The median total cost of hospitalization for all inpatients was $5,942, with a median daily cost of $836. Average daily non-room costs were 282 percent greater on the first hospital day, 59 percent greater on the second day, and 19 percent greater on the third day than the average daily cost throughout the stay. Non-room costs were 14 percent to 72 percent lower on the last 3 days of hospitalization. The researchers projected a mean savings of $680 (ranging from $534 at hospital A to $822 at hospital B) associated with a 1-day reduction in length of stay, with the majority of savings ($495) attributable to room costs.

Brandenburg, J.A., Marrie, T.J., Coley, C.M., and others. (2000). "Clinical presentation, processes, and outcomes of care for patients with pneumococcal pneumonia." Journal of General Internal Medicine 15, pp. 638-646.

Pneumococcal pneumonia is involved in only a small proportion of community-acquired pneumonia (CAP) cases. Half of these patients are at low risk of death. However, many patients with bacteremic pneumococcal pneumonia are still recovering from symptoms a month later compared with shorter symptom resolution for patients who have nonbacteremic pneumonia.

The researchers studied the clinical findings and processes and outcomes of care for inpatients and outpatients with CAP at five medical institutions at three geographic sites. They found that only 7 percent of inpatients and 3 percent of outpatients with CAP had bacteremic pneumococcal pneumonia. These patients typically suffered from cough, labored breathing, and chest pain, and 16 to 22 percent of the patients had blood-stained sputum. There also were many nonrespiratory symptoms. Patients with bacteremic pneumococcal pneumonia were less likely than those with nonbacteremic pneumococcal pneumonia to have sputum production and muscle pains (60 vs. 82 percent and 33 vs. 57 percent, respectively), more likely to have elevated blood urea nitrogen and serum creatinine levels, and more likely to receive penicillin therapy.

Half (49 percent) of the bacteremic patients were in the low-risk category for dying within 30 days (groups I to III), similar to the nonbacteremic patients. None of the 32 bacteremic patients in risk groups I to III died, but 30 percent of patients in high-risk group V died. Bacteremic and nonbacteremic groups had similar intensive care unit admissions and pneumonia-related mortality. However, 46 percent of patients in the bacteremic group had respiratory failure compared with 32 to 37 percent of patients in the nonbacteremic groups.

The complication rate for bacteremic patients was significantly higher than for nonbacteremic patients only for anemia and renal insufficiency. The symptoms of bacteremic pneumococcal pneumonia were slower to resolve than symptoms of nonbacteremic pneumococcal pneumonia, with 63 percent of patients complaining of fatigue at 30 days. Half of the patients still had symptoms of cough, labored breathing, and sputum production, and 13 percent still had chest pain.

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