Process of Care Performance, Patient Characteristics, and Outcomes in Elderly Patients Hospitalized With Community-Acquired or Nursing Home-Acquired Pneumonia

摘要

Study objectives: To compare process of care performance, patient characteristics, and outcomesnin a contemporary cohort of elderly (> 65 years) patients hospitalized with community-acquirednpneumonia (CAP) or with nursing home-acquired pneumonia (NHAP).nDesign: State-wide retrospective cohort study.nSetting: Thirty-four acute-care hospitals in Connecticut.nPatients: Elderly Medicare patients hospitalized in 1995–1996 with CAP (1,131) or with NHAP (528).nMeasurements: Antibiotic administration within8hof hospital arrival, blood culture collection withinn24 h of hospital arrival, oxygenation assessment within 24 h of hospital arrival, demographic andnclinical characteristics, in-hospital complications, mortality, and length of stay.nResults: Process of care performance rates for patients with CAP and NHAP were equivalent fornantibiotic administration within8hof hospital arrival (76.8% vs 76.3%, respectively; p 5 0.82), bloodnculture collection within 24 h of hospital arrival (78.1% vs 81.1%, respectively; p 5 0.31), andnoxygenation assessment within 24 h of hospital arrival (94.7% vs 95.3%, respectively; p 5 0.70).nPatients with CAP were younger than those with NHAP (median age, 80 vs 84 years, respectively;np < 0.001), had less cerebrovascular disease (16.8% vs 34.7%, respectively; p < 0.001), and lowernmortality risk scores at hospital presentation (median, 100 vs 137, respectively; p < 0.001) thannpatients with NHAP. The median length of stay was equivalent (7 days), but the in-hospital mortalitynrate was lower in patients with CAP than in patients with NHAP (8.0% vs 18.6%, respectively;np < 0.001).nConclusion: Initial hospital processes of care are performed at the same rate in patients hospitalizednwith CAP or NHAP. However, patients with CAP are younger, are less acutely and chronically ill, andnhave lower in-hospital mortality rates than patients with NHAP.n(CHEST 2000; 117:1378–1385)