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Researchers compare outcomes for pneumonia patients who receive outpatient treatment with those who are hospitalized

Most outpatients treated for community-acquired pneumonia (CAP) have an excellent prognosis, even though their symptoms may persist for a month. Patients treated for pneumonia in an outpatient setting usually are not as sick when they begin treatment as patients who are hospitalized at the outset. Many of the more seriously ill patients hospitalized with CAP suffer from complications, a later return to usual activities, and sometimes even death, according to the Pneumonia Patient Outcomes Research Team (PORT), which was supported by the Agency for Health Care Policy and Research (HS06468) and led by Wishwa N. Kapoor, M.D., M.P.H., of the University of Pittsburgh.

The researchers conducted a multicenter, prospective, observational study to describe processes of care for CAP and to assess medical outcomes for 944 outpatients and 1,343 hospitalized patients with CAP. Less than 1 percent of outpatients died, only 8 percent of outpatients who survived had one or more medical complications, and only 7.5 percent were later hospitalized. On the other hand, 8 percent of inpatients died, and 80 percent of the deaths were pneumonia-related. Nearly 70 percent of inpatients who survived and 95 percent of those who died had one or more medical complications. Nearly 90 percent of outpatients had returned to usual activities or work by the 30-day followup; 57 percent of nonworking inpatients and 82 percent of working inpatients returned to usual activities during this period.

Results also indicated areas for improving processes of care for CAP. For instance, some form of laboratory testing—such as measurement of a complete blood cell count or serum electrolyte and/or glucose levels—was performed in nearly half of outpatients, but test results were rarely abnormal. This suggests that directed testing (for example, ordering a blood glucose test only for diabetic patients) is preferable to routine laboratory testing of CAP outpatients. On the other hand, only 71 percent of inpatients had blood cultures to identify the specific pathogen causing the pneumonia before initiation of antibiotic therapy. This identifies an area for quality improvement, especially since recent studies have shown improved 30-day survival in patients who have had blood cultures performed within 24 hours of hospital admission, concludes first author Michael J. Fine, M.D., M.Sc.

More details are in "Processes and outcomes of care for patients with community-acquired pneumonia," by Dr. Fine, Roslyn A. Stone, Ph.D., Daniel E. Singer, M.D., and others, in the May 10, 1999 Archives of Internal Medicine 159, pp. 970-980.

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