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On-Site Treatment of Pneumonia in Nursing Home Residents
Hospitalization might not be necessary for some pneumonia patients.
Nursing home residents with pneumonia are often hospitalized. To determine whether some of these hospitalizations can be avoided, investigators conducted a randomized, controlled trial in 20 Canadian nursing homes. Half of the homes were assigned to provide usual care to residents with clinical evidence of lower respiratory tract infections, and half were assigned to follow a clinical algorithm. The algorithm recommended on-site treatment for residents who had lower respiratory tract infections and met the following criteria: ability to eat and drink, pulse 
100 beats per minute, respiratory rate <30 breaths per minute, systolic blood pressure 
90 mm Hg, and oxygen saturation 92% (or 90% for those with chronic lung disease). On-site treatment included daily levofloxacin (500 mg for 10 days) and close monitoring. Residents were transferred to the hospital if their condition worsened and no longer met criteria for on-site treatment.
The study included 680 nursing home residents. Hospitalization rates were significantly lower with the clinical algorithm than with usual care (10% vs. 22%), as were total hospital days (0.79 vs. 1.74). Mortality rates were similar with the two protocols (8% and 9%). Use of the algorithm reduced health care costs by roughly US$1500 per resident.
Comment: The authors calculate that fully implementing this protocol in the U.S. would save roughly $800 million annually, some of which could be used to enhance the supportive care and monitoring required in the protocol.
— Thomas L. Schwenk, MD
Published in Journal Watch General Medicine June 23, 2006
Citation(s):
Loeb M et al. Effect of a clinical pathway to reduce hospitalizations in nursing home residents with pneumonia: A randomized controlled trial. JAMA 2006 Jun 7; 295:2503-10.
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