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.
Retrospective observational study.
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.
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
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