Pneumonia and other lower respiratory tract infections are common among residents of nursing homes. These infections are among the most frequent reasons for transferring residents to a hospital, according to background information in the article. Hospitalization can lead to a reduction in quality of life, a decline in functional status, falls, and other hazards. The economic costs associated with such hospital transfers are substantial. Given the potential hazards to residents and the burden on the health care health system, a strategy for treating residents with pneumonia on-site in the nursing home may be beneficial. However, the effectiveness of providing on-site care has been uncertain.
Mark Loeb, M.D., M.Sc., of McMaster University, Hamilton, Ontario, Canada, and colleagues developed a clinical pathway, or program, for treating nursing home residents with pneumonia or other lower respiratory tract infections on-site in the nursing home to determine if the program would reduce hospitalizations and health care costs. The randomized trial included 680 residents aged 65 years or older, who met a standardized definition of lower respiratory tract infection, in 22 nursing homes in Hamilton, Ontario, Canada. The residents received either usual care or treatment according to the program that was devised, which included use of oral antimicrobials, portable chest radiographs, oxygen saturation monitoring, rehydration, and close monitoring by a research nurse.
Thirty-four residents (10 percent) of 327 residents in the clinical pathway group were hospitalized compared with 76 (22 percent) of 353 residents in the usual care group. Adjusting for the clustering of residents in nursing homes, the weighted
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