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Clinical Investigations: INFECTION |

Frequency of Subspecialty Physician Care for Elderly Patients With Community-Acquired Pneumonia*

Nathan C. Dean, MD, FCCP; Michael P. Silver, MPH; Kim A. Bateman, MD
Author and Funding Information

*From the Pulmonary Division at LDS Hospital (Dr. Dean), the University of Utah (Drs. Dean and Bateman), Salt Lake City, UT; and HealthInsight (Dr. Bateman and Mr. Silver), Salt Lake City, UT. Supported by HealthInsight and Intermountain Health Care. The analyses on which this publication is based were performed under contract number 500–96-P604, entitled, “Utilization and Quality Control Peer Review Organization for the State of Utah,” sponsored by the Health Care Financing Administration, Department of Health and Human Services.

Correspondence to: Nathan Dean, MD, FCCP, Intermountain Health Care, 333 South Ninth East, Salt Lake City, UT 84102; e-mail slndean@ihc.com



Chest. 2000;117(2):393-397. doi:10.1378/chest.117.2.393
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Study objectives: Specialty societies have developed practice guidelines for the treatment of community-acquired pneumonia (CAP). To aid in adapting specialty recommendations for a pneumonia practice guideline at Intermountain Health Care, we investigated which physicians care for pneumonia patients in Utah. We wanted to understand who provides pneumonia care so as to appropriately target the guideline and design tools for implementation.

Design: Retrospective observational study.

Setting: Inpatient and outpatient multicenter.

Patients: The study population comprised 13,919 (16,420 episodes of pneumonia) Utah resident Medicare beneficiaries ≥ 65 years of age who had CAP. Nursing home residents were excluded.

Measurements: We used Health Care Financing Administration billing records from 1993 through 1995 to identify the physicians involved in the care of pneumonia patients by self-designated specialty. We linked patterns of physician involvement to age, sex, residential zip code, 30-day mortality rate, and whether or not the patient was hospitalized.

Results: The involvement of a pneumonia specialist was limited to 11.7% of episodes, with involvement of a pulmonary specialist in 10.6%, an infectious disease (ID) specialist in 0.9%, and the involvement of both specialties in 0.2% of episodes. Greater specialty involvement was observed in episodes resulting in pneumonia hospitalization (20.0% vs 8.6%, respectively; p < 0.0001), death (20.5% vs 11.2%, respectively; p < 0.0001), and episodes among patients with urban county residential zip codes (13.7% vs 7.5%, respectively; p < 0.0001).

Conclusion: Most episodes of pneumonia, including those with serious consequences, are treated by primary care physicians with little or no involvement from pulmonary or ID specialists. It is not known whether greater or lesser specialty physician involvement would change pneumonia costs or clinical outcomes.

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