Study objectives: To compare process of care
performance, patient characteristics, and outcomes in a contemporary
cohort of elderly (≥ 65 years) patients hospitalized with
community-acquired pneumonia (CAP) or with nursing home-acquired
Design: State-wide retrospective
Setting: Thirty-four acute-care
hospitals in Connecticut.
Medicare patients hospitalized in 1995–1996 with CAP (1,131) or with
Measurements: Antibiotic administration
within 8 h of hospital arrival, blood culture collection within
24 h of hospital arrival, oxygenation assessment within 24 h
of hospital arrival, demographic and clinical characteristics,
in-hospital complications, mortality, and length of stay.
Results: Process of care performance rates for patients
with CAP and NHAP were equivalent for antibiotic administration within
8 h of hospital arrival (76.8% vs 76.3%, respectively;
p = 0.82), blood culture collection within 24 h of hospital
arrival (78.1% vs 81.1%, respectively; p = 0.31), and oxygenation
assessment within 24 h of hospital arrival (94.7% vs 95.3%,
respectively; p = 0.70). Patients with CAP were younger than
those with NHAP (median age, 80 vs 84 years, respectively;
p < 0.001), had less cerebrovascular disease (16.8% vs 34.7%,
respectively; p ≤ 0.001), and lower mortality risk scores at
hospital presentation (median, 100 vs 137, respectively; p ≤ 0.001)
than patients with NHAP. The median length of stay was equivalent (7
days), but the in-hospital mortality rate was lower in patients with
CAP than in patients with NHAP (8.0% vs 18.6%, respectively;
p ≤ 0.001).
Conclusion: Initial hospital processes
of care are performed at the same rate in patients hospitalized with
CAP or NHAP. However, patients with CAP are younger, are less acutely
and chronically ill, and have lower in-hospital mortality rates than
patients with NHAP.