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Adherence to pneumonia treatment guidelines results in better outcomes, Pitt study shows

A carefully implemented system of pneumonia care can lead to better outcomes and fewer unnecessary hospitalizations, according to a University of Pittsburgh School of Medicine study published in this week's issue of the Annals of Internal Medicine.

An estimated 5 million pneumonia cases are diagnosed each year in U.S. physician offices and hospital emergency rooms, accounting for 86 million days of restricted activity for those affected and more than $9 billion in health care costs. Despite its prevalence, physicians frequently overestimate the probability of death in many pneumonia patients, leading to potentially unnecessary and costly hospitalizations.

"Pneumonia is common, costly and serious, but for patients at lower risk it often can be treated successfully at home, which is what many low-risk patients prefer at 1/20th the cost of hospitalization," said Michael Fine, M.D., professor of medicine at the University of Pittsburgh, author of the study and a noted expert in the treatment of pneumonia.

The year-long, multi-center randomized trial conducted by investigators from the University of Pittsburgh School of Medicine and the Pittsburgh VA Healthcare System involved 32 hospital emergency departments in Connecticut and southwestern Pennsylvania and more than 3,200 patients, all of whom were diagnosed with pneumonia but who posed varying risks of adverse outcomes from the disease.

"A unique aspect to this study was the use of one of three different interventions at sites, each of varying intensity, allowing us not only to alter care, but also to determine the amount of effort needed to create change," noted lead author Donald M. Yealy, M.D., professor and vice chair of emergency medicine at the University of Pittsburgh. "Similar efforts in the past have employed a singular 'one size fits all' approach," he observed.

For the purposes of this study, participating emergency departments were randomly assigned as low-intensity,
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