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Vol. 41. Issue 6.
Pages 300-306 (June 2005)
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Vol. 41. Issue 6.
Pages 300-306 (June 2005)
Original Articles
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Patients Hospitalized With Community-Acquired Pneumonia: a Comparative Study of Outcomes by Medical Specialty Area
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A. Capelasteguia,
Corresponding author
acapelas@hgda.osakidetza.net

Correspondence: Dr. A. Capelastegui. Servicio de Neumología. Hospital de Galdakao. B. Labeaga, s/n. 48960 Galdakao. Bizkaia. España
, P.P. Españaa, J.M. Quintanab, I. Gorordoa, A. Martínez Urquiric, I. Idoiagad, A. Bilbaob
a Servicio de Neumología, Hospital de Galdakao, Galdakao, Bizkaia, Spain
b Unidad de Investigación, Hospital de Galdakao, Galdakao, Bizkaia, Spain
c Servicio de Urgencias, Hospital de Galdakao, Galdakao, Bizkaia, Spain
d Medicina de Familia, Hospital de Galdakao, Galdakao, Bizkaia, Spain
Article information
Objective

Variability in the management of patients hospitalized with community-acquired pneumonia (CAP) is attributable to many factors. The objective of this study was to determine whether such variability is influenced by the medical specialty area where the patient is treated.

Patients and methods

The treatment and outcomes for a random sample of patients with CAP admitted to 4 hospitals over 2 periods (1 year starting March 1, 1998, and 1.5 years starting March 1, 2000) were compared by medical specialty department. Multiple linear and logistic regression models were used to analyze differences.

Results

Differences were found between departments in the coverage of atypical pathogens (P <.001). The adjusted mean length of stay in hospital varied between 6.8 and 9.1 days (P <.01), and the duration of intravenous treatment varied between 4.6 and 7.3 days (P <.05). Adjusted models showed that mortality in hospital and at 30 days was significantly higher for patients treated in internal medicine departments (odds ratios: 2.1 and 2, respectively) than for those treated in pulmonology departments.

Conclusions

Interdepartmental differences were observed in how patients hospitalized with CAP were treated and in the outcomes achieved. This variation is probably influenced by the differences that were found in the use of antibiotics.

Key words:
Community-acquired pneumonia
Variability
Treatment
Results
Objetivo

La variabilidad en el manejo de los pacientes ingresados por una neumonía adquirida en la comunidad (NAC) es multifactorial. Nuestro objetivo fue comprobar si en ello influye la especialidad del servicio responsable.

Pacientes y métodos

Se compararon entre servicios el tratamiento y los resultados de una muestra aleatoria de los pacientes ingresados por NAC en 4 hospitales durante 2 perío-dos (un año desde el 1 de marzo de 1998; un año y medio des-de el 1 de marzo de 2000). Se emplearon modelos de regresión lineal múltiple y logística para ajustar las diferencias.

Resultados

Se encontraron diferencias entre servicios en la cobertura de gérmenes atípicos (p < 0,001). La duración media ajustada de la estancia hospitalaria osciló entre 6,8 y 9,1 días (p < 0,01) y la del tratamiento intravenoso entre 4,6 y 7,3 días (p < 0,05). Los análisis ajustados demostraron que la mortalidad intrahospitalaria y a los 30 días fue significativa-mente superior en los servicios de medicina interna (odds ratio: 2,1 y 2, respectivamente) respecto a los de neumología.

Conclusiones

Se observaron diferencias entre servicios en el tratamiento de los pacientes ingresados por NAC y en sus resultados. Es probable que en ello influyan las diferencias encontradas en la utilización de los antibióticos.

Palabras clave:
Neumonía adquirida en la comunidad
Variabilidad
Tratamiento
Resultados
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REFERENCES
[1]
MJ Fine, TE Auble, DM Yealy, et al.
A prediction rule to identify low-risk patients with community-acquired pneumonia.
N Engl J Med, 336 (1997), pp. 243-250
[2]
PP España, A Capelastegui, JM Quintana, et al.
A prediction rule to identify allocation of inpatient care in community-acquired pneumonia.
Eur Respir J, 21 (2003), pp. 695-701
[3]
S Ewig, T Kleinfeld, T Bauer, K Seifert, H Schafer, N Goke.
Comparative validation of prognostic rules for community-acquired pneumonia in a elderly population.
Eur Respir J, 14 (1998), pp. 370-375
[4]
AM Neill, IR Martin, R Weir, et al.
Community acquired pneumonia: aetiology and usefulness of severity criteria on admission.
Thorax, 51 (1996), pp. 1010-1016
[5]
TP Meehan, MJ Fine, HM Krumholz, et al.
Quality of care, process, and outcomes in elderly patients with pneumonia.
JAMA, 278 (1997), pp. 2080-2084
[6]
PP Gleason, TP Meehan, JM Fine, DH Galusha, MJ Fine.
Associations between initial antimicrobial therapy and medical outcomes for hospitalized elderly patients with pneumonia.
Arch Intern Med, 159 (1999), pp. 2562-2572
[7]
JE Stahl, M Barza, J Desfardin, R Martin, MH Eckman.
Effect of macrolides as part of initial empiric therapy on length of stay in patients hospitalized with community-acquired pneumonia.
Arch Intern Med, 159 (1999), pp. 2576-2580
[8]
MJ Fine, DN Singer, AL Phelps, BH Hanusa, WN Kapoor.
Differences in the length of stay in patients with community-acquired pneumonia: a prospective four-hospital study.
Med Care, 31 (1993), pp. 371-380
[9]
BG Feagan, TJ Marrie, CY Lau, SL Wheeler, CJ Wong, MK Vandervoort.
Treatment and outcomes of community-acquired pneumonia at Canadian hospitals.
Can Med Assoc J, 162 (2000), pp. 1415-1420
[10]
D McCormick, MJ Fine, CM Coley, et al.
Variation in length of hospital stay in patients with community-acquired pneumonia: are shorter stays associated with worse medical outcomes?.
Am J Med, 107 (1999), pp. 5-12
[11]
Y Jin, TJ Marrie, KC Carriere, et al.
Variation in management of community-acquired pneumonia requiring admission to Alberta, Canada hospitals.
Epidemiol Infect, 130 (2001), pp. 41-51
[12]
JE Wennberg, JL Freeman, WJ Culp.
Are hospital services rationed in New Haven or over-utilized in Boston?.
Lancet, 1 (1987), pp. 1185-1189
[13]
JE Wennberg, K McPherson, P Caper.
Will payment based on diagnosis-related groups control hospital costs?.
N Engl J Med, 311 (1984), pp. 295-300
[14]
A Ortqvist.
Antibiotic treatment of community-acquired pneumonia in clinical practice: a European survey.
J Antimicrob Chemother, 35 (1995), pp. 205-212
[15]
GJ Huchon, G Gialdroni-Grassi, P Leophonte, F Manresa, T Schaberg, M Woodhead.
Initial antibiotic therapy for lower respiratory tract infection in the community: a European survey.
Eur Respir J, 9 (1996), pp. 1590-1595
[16]
K Gilbert, PP Gleason, DE Singer, et al.
Variations in antimicrobial use and cost in more than 2000 patients with community-acquired pneumonia.
Am J Med, 104 (1998), pp. 17-27
[17]
MJ Fine, MA Smith, CA Carson, et al.
Prognosis and outcomes of patients with community-acquired pneumonia: a meta-analysis.
JAMA, 275 (1996), pp. 134-141
[18]
TJ Marrie, KC Carriere, Y Jin, DH Johnson.
Mortality during hospitalisation for pneumonia in Alberta, Canada, is associated with physician volume.
Eur Respir J, 22 (2003), pp. 148-155
[19]
P Jong, Y Gong, PP Liu, PC Austin, DS Lee, JV Tu.
Care and outcomes of patients newly hospitalized for heart failure in the community treated by cardiologists compared with other specialists.
Circulation, 108 (2003), pp. 184-191
[20]
LR Harrold, TS Field, JH Gurwitz.
Knowledge, patterns of care, and outcomes of care for general internists and specialists.
J Gen Intern Med, 14 (1999), pp. 499-511
[21]
A Pardo, R Durández, M Hernández, et al.
Impact of specialty on the cost of nonvariceal upper GI bleeding care.
Am J Gastroenterol, 97 (2002), pp. 1535-1542
[22]
S Ewig, M Ruiz, J Mensa, et al.
Severe community-acquired pneumonia: assessment of severity criteria.
Am J Respir Crit Care Med, 158 (1998), pp. 1102-1108
[23]
J Dorca, S Bello, J Blanquer, et al.
Diagnóstico y tratamiento de la neumonía adquirida en la comunidad. SEPAR. Sociedad Española de Neumología y Cirugía Toracica.
Arch Bronconeumol, 33 (1997), pp. 240-246
[24]
JP Metlay, R Schulz, YH Li, et al.
Influence of age on symptoms at presentation in patients with community-acquired pneumonia.
Arch Intern Med, 157 (1997), pp. 1453-1459
[25]
R Fernández Álvarez, JA Gullón Blanco, G Rubinos Cuadrado, et al.
Neumonía adquirida en la comunidad: influencia de la duración de la antibioterapia intravenosa en la estancia hospitalaria y relación coste/efectividad.
Arch Bronconeumol, 37 (2001), pp. 366-370
[26]
DC Rhew, GS Tu, J Ofman, JM Henning, MS Richards, SC Weingarten.
Early switch and early discharge strategies in patients with community-acquired pneumonia: a meta-analysis.
Arch Intern Med, 161 (2001), pp. 722-727
[27]
DC Rhew, MB Goetz, PG Shekelle.
Evaluating quality indicators for patients with community-acquired pneumonia.
J Qual Improv, 27 (2001), pp. 575-590
[28]
EA Halm, MJ Fine, WN Kapoor, DE Singer, TJ Marrie, AL Siu.
Instability on hospital discharge and the risk of adverse outcomes in patients with pneumonia.
Arch Intern Med, 162 (2002), pp. 1278-1284
[29]
WS Lim, MM van der Eerden, R Laing, et al.
Defining community-acquired pneumonia severity on presentation to hospital: an international derivation and validation study.
Thorax, 58 (2003), pp. 377-382
[30]
DC Angus, TJ Marrie, S Obrosky, et al.
Severe community-acquired pneumonia: use of intensive care services and evaluation of American and British Thoracic Society diagnostic criteria.
Am J Respir Crit Care Med, 166 (2002), pp. 717-723
[31]
LJ Eron, S Passos.
Early discharge of infected patients through appropriate antibiotic use.
Arch Intern Med, 161 (2001), pp. 61-65
Copyright © 2005. Sociedad Española de Neumología y Cirugía Torácica (SEPAR)
Archivos de Bronconeumología

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