[PHNUTR-L] Keeping Nursing Home Residents with Pneumonia out of the
Kathrynne Holden, MS, RD
fivestar at nutritionucanlivewith.com
Thu Jun 8 05:12:25 PDT 2006
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Keeping Nursing Home Residents with Pneumonia out of the Hospital
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.
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
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
"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
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 >
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