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Management of Pneumonia in the Nursing Home

Ali A. El-Solh, MD, FCCP; Mike S. Niederman, MD, FCCP; Paul Drinka, MD
Author and Funding Information

From the Division of Pulmonary, Critical Care, and Sleep Medicine (Dr El-Solh), Veterans Affairs Western New York Healthcare System, and Department of Medicine (Dr El-Solh), University at Buffalo School of Medicine and Biomedical Sciences, Buffalo, NY; Department of Medicine (Dr Niederman), Winthrop-University Hospital, Mineola, NY; Department of Medicine (Dr Niederman), SUNY Stony Brook School of Medicine, Stony Brook, NY; Department of Internal Medicine/Geriatrics (Dr Drinka), University of Wisconsin, Madison, WI; and Medical College of Wisconsin (Dr Drinka), Milwaukee, WI.

Correspondence to: Ali El-Solh, MD, FCCP, Division of Pulmonary, Critical Care, and Sleep Medicine, Veterans Affairs Western New York Healthcare System, 3495 Bailey Ave, Buffalo, NY 14215-1199; solh@buffalo.edu


Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (http://www.chestpubs.org/site/misc/reprints.xhtml).


© 2010 American College of Chest Physicians


Chest. 2010;138(6):1480-1485. doi:10.1378/chest.10-1135
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Pneumonia is a major cause of morbidity and mortality among nursing home residents. The approach to managing these patients has lacked uniformity because of the paucity of clinical trials, complexity of underlying comorbid diseases, and heterogeneity of administrative structures. The decision to hospitalize nursing home patients with pneumonia varies among institutions depending on staffing level, availability of diagnostic testing, and laboratory support. In the absence of comparative studies, choice of empirical antibiotic therapy continues to be based on expert opinion. Validated prognostic scoring models are needed for risk stratification. Pneumococcal and influenza vaccination are the primary prevention measures. As of January 2010, Medicare no longer pays for consultation codes; thus, practitioners must instead use existing evaluation and management service codes when providing these services.


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