title: Frequency of subspecialty physician care for elderly patients with community-acquired pneumonia.
abstract: OBJECTIVE
  Specialty societies have developed practice guidelines for the treatment of community-acquired pneumonia (CAP). To aid in adapting specialty recommendations for a pneumonia practice guideline at Intermountain Health Care, we investigated which physicians care for pneumonia patients in Utah. We wanted to understand who provides pneumonia care so as to appropriately target the guideline and design tools for implementation.
  
  
  METHODS
  Retrospective observational study.
  
  
  METHODS
  Inpatient and outpatient multicenter.
  
  
  METHODS
  The study population comprised 13,919 (16,420 episodes of pneumonia) Utah resident Medicare beneficiaries > or = 65 years of age who had CAP. Nursing home residents were excluded.
  
  
  METHODS
  We used Health Care Financing Administration billing records from 1993 through 1995 to identify the physicians involved in the care of pneumonia patients by self-designated specialty. We linked patterns of physician involvement to age, sex, residential zip code, 30-day mortality rate, and whether or not the patient was hospitalized.
  
  
  RESULTS
  The involvement of a pneumonia specialist was limited to 11.7% of episodes, with involvement of a pulmonary specialist in 10.6%, an infectious disease (ID) specialist in 0.9%, and the involvement of both specialties in 0.2% of episodes. Greater specialty involvement was observed in episodes resulting in pneumonia hospitalization (20.0% vs 8.6%, respectively; p < 0.0001), death (20.5% vs 11.2%, respectively; p < 0.0001), and episodes among patients with urban county residential zip codes (13.7% vs 7.5%, respectively; p < 0.0001).
  
  
  CONCLUSIONS
  Most episodes of pneumonia, including those with serious consequences, are treated by primary care physicians with little or no involvement from pulmonary or ID specialists. It is not known whether greater or lesser specialty physician involvement would change pneumonia costs or clinical outcomes.
authors.affiliation: Pulmonary Division at LDS Hospital, the University of Utah, Salt Lake City, UT, USA. slndean@ihc.com
authors.forename: N C
authors.initials: NC
authors.lastname: Dean
authors.forename: M P
authors.initials: MP
authors.lastname: Silver
authors.forename: K A
authors.initials: KA
authors.lastname: Bateman
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D017714:Community-Acquired Infections / Q000401:mortality / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D008511:Medicine / Q000706:statistics & numerical data*; D010343:Patient Admission / Q000706:statistics & numerical data; D010348:Patient Care Team / Q000706:statistics & numerical data*; D011014:Pneumonia / Q000401:mortality / Q000628:therapy*; D011320:Primary Health Care / Q000706:statistics & numerical data; D013038:Specialization; D015996:Survival Rate; D014589:Utah