Process of care performance, patient characteristics, and outcomes in elderly patients hospitalized with community-acquired or nursing home-acquired pneumonia.
OBJECTIVE
To compare process of care performance, patient characteristics, and outcomes in a contemporary cohort of elderly (> or = 65 years) patients hospitalized with community-acquired pneumonia (CAP) or with nursing home-acquired pneumonia (NHAP).


METHODS
State-wide retrospective cohort study.


METHODS
Thirty-four acute-care hospitals in Connecticut.


METHODS
Elderly Medicare patients hospitalized in 1995-1996 with CAP (1,131) or with NHAP (528).


METHODS
Antibiotic administration within 8 h of hospital arrival, blood culture collection within 24 h of hospital arrival, oxygenation assessment within 24 h of hospital arrival, demographic and clinical characteristics, in-hospital complications, mortality, and length of stay.


RESULTS
Process of care performance rates for patients with CAP and NHAP were equivalent for antibiotic administration within 8 h of hospital arrival (76.8% vs 76.3%, respectively; p = 0.82), blood culture collection within 24 h of hospital arrival (78.1% vs 81.1%, respectively; p = 0.31), and oxygenation assessment within 24 h of hospital arrival (94.7% vs 95. 3%, respectively; p = 0.70). Patients with CAP were younger than those with NHAP (median age, 80 vs 84 years, respectively; p < 0. 001), had less cerebrovascular disease (16.8% vs 34.7%, respectively; p < or = 0.001), and lower mortality risk scores at hospital presentation (median, 100 vs 137, respectively; p < or = 0. 001) than patients with NHAP. The median length of stay was equivalent (7 days), but the in-hospital mortality rate was lower in patients with CAP than in patients with NHAP (8.0% vs 18.6%, respectively; p < or = 0.001).


CONCLUSIONS
Initial hospital processes of care are performed at the same rate in patients hospitalized with CAP or NHAP. However, patients with CAP are younger, are less acutely and chronically ill, and have lower in-hospital mortality rates than patients with NHAP.
Meehan
T P
TP
Department of Medicine, Yale University School of Medicine, New Haven, CT 06457, USA. TMEEHAN@SDPS.ORG
Chua-Reyes
J M
JM
Tate
J
J
Prestwood
K M
KM
Scinto
J D
JD
Petrillo
M K
MK
Metersky
M L
ML
D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D017714:Community-Acquired Infections / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D003237:Connecticut; D003428:Cross Infection / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D005260:Female; D015577:Geriatric Assessment; D006707:Homes for the Aged; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D009735:Nursing Homes; D010343:Patient Admission; D018410:Pneumonia, Bacterial / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D017064:Process Assessment, Health Care; D012189:Retrospective Studies; D016019:Survival Analysis