[PHNUTR-L] Keeping Nursing Home Residents with Pneumonia out of the Hospital

[Kathrynne Holden, MS, RD]

Colleagues, the following is FYI and does not necessarily reflect my own
opinion. I have no further knowledge of the topic. If you do not wish to
receive these posts, set your email filter to filter out any messages
coming from   @nutritionucanlivewith.com    and the program will remove
anything coming from me.
---------------------------------------------------------
Keeping Nursing Home Residents with Pneumonia out of the Hospital
http://www.medpagetoday.com/PrimaryCare/Geriatrics/dh/3483		
   	
By Jeff Minerd, MedPage Today Staff Writer
Reviewed by Zalman S. Agus, MD; Emeritus Professor at the University of 
Pennsylvania School of Medicine.
June 06, 2006
Also covered by: Forbes
MedPage Today Action Points

     * Explain to patients that this study suggests the chief benefit of 
the new treatment program is health care cost savings. The program would 
reduce hospitalizations for nursing home residents with pneumonia but 
would not reduce morbidity or mortality compared with standard care.

Review
HAMILTON, Ontario, June 6 — A more intensive program of treating 
pneumonia in nursing home residents can keep many of them out of the 
hospital, researchers here said.

While the new treatment program did not improve mortality rates or other 
patient outcomes, it substantially reduced hospitalizations, saving more 
than $1,000 (U.S.) in health care costs per patient, said Mark Loeb, 
M.D., M.Sc., of McMaster University here.

If the program, which was developed by Dr. Loeb and colleagues, were 
employed throughout the United Sates, it could save more than $800 
million annually in health care costs, the investigators said in the 
June 7 issue of the Journal of the American Medical Association.

The study involved nearly 700 residents of 22 nursing homes here with 
pneumonia and other lower respiratory tract infections during 2001 to 
2005. Roughly half the participants were randomized to receive usual 
care, which was whatever the resident physician deemed appropriate. The 
other half received a prescribed program of treatment that included oral 
antimicrobials, chest x-rays performed by a mobile unit, oxygen 
saturation monitoring, rehydration, and close monitoring by a study nurse.

Thirty-four (10%) of 327 residents in the intervention group were 
hospitalized compared with 76 (22%) of 353 residents in the usual-care 
group. The mean reduction in hospitalizations was 12% (95% confidence 
interval=5% to 18%; P=.001).

The mean number of hospital days per resident was 0.79 in the 
intervention group versus 1.74 in the usual care group, with a mean 
difference of 0.95 days per resident (95% CI=0.34 to 1.55 days; P=.004).

The mortality rate was 8% (24 deaths) in the intervention group compared 
with 9% (32 deaths) in the usual care group, with a mean difference of 
2.9% (95% CI= -2.0% to 7.9%; P=.23). There were no significant 
differences between the groups in health-related quality of life or 
functional status.

The new treatment program resulted in an overall cost savings of $1,016 
(U.S.) per patient (95% CI=$2.07 to $1,824), the researchers said.

"These results confirm observational studies in which rates of death did 
not differ between residents with pneumonia who were transferred and 
those who remained onsite in the nursing home," the authors said. "Our 
data suggest that hospitalization of residents of nursing homes for 
pneumonia and other lower respiratory tract infections has little impact 
on mortality."

"These data have important implications for the delivery of health care 
services for both long-term care facilities and acute care hospitals," 
the authors said. "Treating nursing home residents with pneumonia with 
the clinical pathway approach can reduce the burden to emergency 
departments and inpatient hospital units, particularly during influenza 
season, when many nursing home residents with pneumonia are frequently 
sent to the hospital."

"Based on an estimated 1.5 million elderly residents in nursing homes in 
the United States and using U.S. costs, the cost savings of implementing 
clinical pathways in the United States could approximate $831 million 
per year," they concluded.

Implementing the program in the United States, with its multiple-payer 
health care system, would be more difficult than implementing the 
program in Canada, with its single-payer system, the authors said. One 
challenge in the United States would be that nursing homes would bear 
the burden of additional cost, while hospitals would realize the benefit 
of cost savings.

For the program to work in the United States, nursing homes would need 
to receive supplemental funds to cover its cost, the authors said.

Primary source: Journal of the American Medical Association
Source reference:
Mark Loeb et al. "Effect of a clinical pathway to reduce 
hospitalizations in nursing home residents with pneumonia." Journal of 
the American Medical Association 2006; 295:2503-2510.
-- 
Kathrynne Holden, MS, RD < fivestar at nutritionucanlivewith.com >
"Ask the Parkinson Dietitian"  http://www.parkinson.org/
"Eat well, stay well with Parkinson's disease"
"Parkinson's disease: Guidelines for Medical Nutrition Therapy"
http://www.nutritionucanlivewith.com/