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Processes and Outcomes of Care for Patients With Community-Acquired Pneumonia
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).
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