This Article  • Full text  • PDF  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Citing articles on Web of Science (124)  • Contact me when this article is cited  Related Content  • Related article  • Similar articles in this journal  Topic Collections  • Bacterial Infections  • Infectious Diseases, Other  • Pathology & Laboratory Medicine  • Pneumonia  • Alert me on articles by topic  Social Bookmarking   What's this?

Results From the Pneumonia Patient Outcomes Research Team (PORT) Cohort Study

Michael J. Fine, MD, MSc; Roslyn A. Stone, PhD; Daniel E. Singer, MD; Christopher M. Coley, MD; Thomas J. Marrie, MD; Judith R. Lave, PhD; Linda J. Hough, MPH; D. Scott Obrosky, MSc; Richard Schulz, PhD; Edmund M. Ricci, PhD; Joan C. Rogers, PhD; Wishwa N. Kapoor, MD, MPH

Arch Intern Med. 1999;159:970-980.

Background  Although understanding the processes of care and medical outcomes for patients with community-acquired pneumonia is instrumental to improving the quality and cost-effectiveness of care for this illness, limited information is available on how physicians manage patients with this illness or on medical outcomes other than short-term mortality.

Objectives  To describe the processes of care and to assess a broad range of medical outcomes for ambulatory and hospitalized patients with community-acquired pneumonia.

Methods  This prospective, observational study was conducted at 4 hospitals and 1 health maintenance organization in Pittsburgh, Pa, Boston, Mass, and Halifax, Nova Scotia. Data were collected via patient interviews and reviews of medical records for 944 outpatients and 1343 inpatients with clinical and radiographic evidence of community-acquired pneumonia. Processes of care and medical outcomes were assessed 30 days after presentation.

Results  Only 29.7% of outpatients had 1 or more microbiologic tests performed, and only 5.7% had an assigned microbiologic cause. Although 95.7% of inpatients had 1 or more microbiologic tests performed, a cause was established in only 29.6%. Six outpatients (0.6%) died, and 3 of these deaths were pneumonia related. Of surviving outpatients, 8.0% had 1 or more medical complications. At 30 days, 88.9% (nonemployed) to 95.6% (employed) of the surviving outpatients had returned to usual activities, yet 76.0% of outpatients had 1 or more persisting pneumonia-related symptoms. Overall, 107 inpatients (8.0%) died, and 81 of these deaths were pneumonia related. Most surviving inpatients (69.0%) had 1 or more medical complications. At 30 days, 57.3% (nonemployed) to 82.0% (employed) of surviving inpatients had returned to usual activities, and 86.1% had 1 or more persisting pneumonia-related symptoms.

Conclusions  In this study, conducted primarily at hospital sites with affiliated medical education training programs, virtually all outpatients and most inpatients had pneumonia of unknown cause. Although outpatients had an excellent prognosis, pneumonia-related symptoms often persisted at 30 days. Inpatients had substantial mortality, morbidity, and pneumonia-related symptoms at 30 days.

From the Division of General Internal Medicine, Department of Medicine (Drs Fine and Kapoor, Ms Hough, and Mr Obrosky), Departments of Health Services Administration (Drs Lave and Ricci) and Biostatistics (Dr Stone), Graduate School of Public Health, Department of Psychiatry (Drs Schulz and Rogers), and Center for Research on Health Care (Drs Fine, Stone, Lave, Ricci, and Kapoor, Ms Hough, and Mr Obrosky), University of Pittsburgh, Pittsburgh, Pa; General Internal Medicine Division, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston (Drs Singer and Coley); and Departments of Medicine and Microbiology, Queen Elizabeth II Health Sciences Center and Dalhousie University, Halifax, Nova Scotia (Dr Marrie).

CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    Twitter     What's this?

RELATED ARTICLE

Archives of Internal Medicine Reader's Choice: Continuing Medical Education
Arch Intern Med. 1999;159(9):1015-1016.
FULL TEXT  

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Pneumonia mortality in a UK general practice population cohort
Myles et al.
Eur J Public Health 2009;19:521-526.
ABSTRACT | FULL TEXT  

Green tea and death from pneumonia in Japan: the Ohsaki cohort study
Watanabe et al.
Am. J. Clin. Nutr. 2009;90:672-679.
ABSTRACT | FULL TEXT  

Acute Lung Injury Outside of the ICU: Incidence in Respiratory Isolation on a General Ward
Quartin et al.
Chest 2009;135:261-268.
ABSTRACT | FULL TEXT  

Public Reporting of Antibiotic Timing in Patients with Pneumonia: Lessons from a Flawed Performance Measure
Wachter et al.
ANN INTERN MED 2008;149:29-32.
ABSTRACT | FULL TEXT  

Determinants of hospital costs in community-acquired pneumonia
Reyes et al.
Eur Respir J 2008;31:1061-1067.
ABSTRACT | FULL TEXT  

Pneumonia in incident dialysis patients--the United States Renal Data System
Guo et al.
Nephrol Dial Transplant 2008;23:680-686.
ABSTRACT | FULL TEXT  

Pneumonia Severity Index Class V Patients With Community-Acquired Pneumonia: Characteristics, Outcomes, and Value of Severity Scores
Valencia et al.
Chest 2007;132:515-522.
ABSTRACT | FULL TEXT  

Discriminating Inhalational Anthrax From Community-Acquired Pneumonia Using Chest Radiograph Findings and a Clinical Algorithm
Kyriacou et al.
Chest 2007;131:489-496.
ABSTRACT | FULL TEXT  

Prognostic score systems and community-acquired bacteraemic pneumococcal pneumonia
Spindler and Ortqvist
Eur Respir J 2006;28:816-823.
ABSTRACT | FULL TEXT  

Long-term Symptom Recovery and Health-Related Quality of Life in Patients With Mild-to-Moderate-Severe Community-Acquired Pneumonia.
el Moussaoui et al.
Chest 2006;130:1165-1172.
ABSTRACT | FULL TEXT  

Severe sepsis in community-acquired pneumonia: when does it happen, and do systemic inflammatory response syndrome criteria help predict course?
Dremsizov et al.
Chest 2006;129:968-978.
ABSTRACT | FULL TEXT  

Guidelines for the Treatment of Community-acquired Pneumonia: Predictors of Adherence and Outcome
Menendez et al.
Am. J. Respir. Crit. Care Med. 2005;172:757-762.
ABSTRACT | FULL TEXT  

Understanding variation in quality of antibiotic use for community-acquired pneumonia: effect of patient, professional and hospital factors
Schouten et al.
J Antimicrob Chemother 2005;56:575-582.
ABSTRACT | FULL TEXT  

Management of Community-Acquired Pneumonia in the Home: An American College of Chest Physicians Clinical Position Statement
Ramsdell et al.
Chest 2005;127:1752-1763.
ABSTRACT | FULL TEXT  

Lower Respiratory Viral Illnesses: Improved Diagnosis by Molecular Methods and Clinical Impact
Garbino et al.
Am. J. Respir. Crit. Care Med. 2004;170:1197-1203.
ABSTRACT | FULL TEXT  

Limited Impact of a Multicenter Intervention To Improve the Quality and Efficiency of Pneumonia Care
Halm et al.
Chest 2004;126:100-107.
ABSTRACT | FULL TEXT  

Development and validation of a short questionnaire in community acquired pneumonia
El Moussaoui et al.
Thorax 2004;59:591-595.
ABSTRACT | FULL TEXT  

Shoot, Ready, Aim: Pneumonia Care Quality and Costs in a Community Hospital
Milo et al.
American Journal of Medical Quality 2003;18:214-219.
ABSTRACT  

Impact of antimicrobial resistance on health outcomes in the out-patient treatment of adult community-acquired pneumonia: a probability model
Singer et al.
J Antimicrob Chemother 2003;51:1269-1282.
ABSTRACT | FULL TEXT  

Antibiotic Therapy for Ambulatory Patients With Community-Acquired Pneumonia in an Emergency Department Setting
Malcolm and Marrie
Arch Intern Med 2003;163:797-802.
ABSTRACT | FULL TEXT  

Improving the Quality of Care for Patients With Pneumonia in Very Small Hospitals
Chu et al.
Arch Intern Med 2003;163:326-332.
ABSTRACT | FULL TEXT  

Testing Strategies in the Initial Management of Patients with Community-Acquired Pneumonia
Metlay and Fine
ANN INTERN MED 2003;138:109-118.
ABSTRACT | FULL TEXT  

Management of Community-Acquired Pneumonia
Halm and Teirstein
NEJM 2002;347:2039-2045.
FULL TEXT  

An Intervention To Improve Antibiotic Delivery and Sputum Procurement in Patients Hospitalized With Community-Acquired Pneumonia*
Lawrence et al.
Chest 2002;122:913-919.
ABSTRACT | FULL TEXT  

Severe Community-acquired Pneumonia: Use of Intensive Care Services and Evaluation of American and British Thoracic Society Diagnostic Criteria
Angus et al.
Am. J. Respir. Crit. Care Med. 2002;166:717-723.
ABSTRACT | FULL TEXT  

Instability on Hospital Discharge and the Risk of Adverse Outcomes in Patients With Pneumonia
Halm et al.
Arch Intern Med 2002;162:1278-1284.
ABSTRACT | FULL TEXT  

Does Acute Organ Dysfunction Predict Patient-Centered Outcomes?*
Clermont et al.
Chest 2002;121:1963-1971.
ABSTRACT | FULL TEXT  

Causes of Death for Patients With Community-Acquired Pneumonia: Results From the Pneumonia Patient Outcomes Research Team Cohort Study
Mortensen et al.
Arch Intern Med 2002;162:1059-1064.
ABSTRACT | FULL TEXT  

Processes of Care, Illness Severity, and Outcomes in the Management of Community-Acquired Pneumonia at Academic Hospitals
Dedier et al.
Arch Intern Med 2001;161:2099-2104.
ABSTRACT | FULL TEXT  

Evaluation of a Computerized Diagnostic Decision Support System for Patients with Pneumonia: Study Design Considerations
Aronsky et al.
J. Am. Med. Inform. Assoc. 2001;8:473-485.
ABSTRACT | FULL TEXT  

Nonsevere Community-Acquired Pneumonia: Correlation Between Cause and Severity or Comorbidity
Falguera et al.
Arch Intern Med 2001;161:1866-1872.
ABSTRACT | FULL TEXT  

Initial risk class and length of hospital stay in community-acquired pneumonia
Menendez et al.
Eur Respir J 2001;18:151-156.
ABSTRACT | FULL TEXT  

Cost-effectiveness of Gatifloxacin vs Ceftriaxone With a Macrolide for the Treatment of Community-Acquired Pneumonia
Dresser et al.
Chest 2001;119:1439-1448.
ABSTRACT | FULL TEXT