New Prediction Method Could Cut Hospital Admissions and Costs for Pneumonia Patients

Media Advisory Date: January 23, 1997

The Federal Agency for Health Care Policy and Research (AHCPR) today announced a simple and accurate method to predict which patients with pneumonia may be treated at home rather than in a hospital. The prediction method—a clinical model used to help doctors assess the need for hospitalization—also could help reduce the over $4 billion spent annually for inpatient care. This model is described in the January 23 issue of the New England Journal of Medicine.

About 600,000, or 15 percent, of the 4 million Americans who develop pneumonia each year are hospitalized. Because of the lack of evidence-based admission criteria and the tendency to overestimate the risk of death, many low-risk patients who could be safely treated outside the hospital are admitted for inpatient care. Hospitalization costs for this disease are estimated to be 10 to 15 times higher than outpatient therapy.

The prediction method is intended to help doctors identify more accurately and easily which pneumonia patients do not require intensive treatment. Projections made from a prospective study by the researchers of roughly 2,300 individuals in Pittsburgh, Pa., Boston, Mass., and Halifax, Nova Scotia, who were treated for pneumonia at home or in the hospital, suggest that 26 to 31 percent of those hospitalized could have been treated on an outpatient basis, had the model been used. Another 13 to 19 percent of the inpatients could have been hospitalized only briefly for observation.

While the researchers caution there may be other factors that should be considered before assigning a patient to outpatient care, including patient preferences, the ability to drink fluids and take medication by mouth, presence of a caregiver or certain severe medical conditions, they conclude that they have enough preliminary evidence to show their prediction method could reduce hospitalizations without jeopardizing patient health and quality of care. In addition, it may assure that high-risk patients are appropriately admitted to the hospital.

The findings, which were reported by Michael J. Fine, M.D., M.Sc., associate professor of medicine at the University of Pittsburgh School of Medicine, and co-investigators from the University of Pittsburgh, Harvard Medical School and Dalhousie University, are from the AHCPR-funded study on the Assessment of Variations and Outcomes for Community-Acquired Pneumonia, which was directed by Wishwa N. Kapoor, M.D., M.P.H., also of the University of Pittsburgh. The New England Journal of Medicine article is entitled, "A Prediction Rule To Identify Low-Risk Patients With Community-Acquired Pneumonia."

AHCPR's pneumonia study is part of a major effort to reduce physician uncertainty and improve treatment effectiveness. The findings are summarized in two fact sheets: What's New for Clinicians: Pneumonia, New Prediction Model Proves Promising and What's New for Consumers: Pneumonia, More Patients May Be Treated At Home. Both are available from the AHCPR Publications Clearinghouse, P.O. Box 8547, Silver Spring, MD, 20907; telephone 800-358-9295. A copy of this study's final report (AHCPR Publication No. 97-N009) can be obtained from the Clearinghouse (AHCPR Pub. No. 97-N009) or the National Technical Information Service, 5285 Port Royal Road, Springfield, VA, 22161, or call (703) 487-4650. Ask for accession number PB97-117808.

For additional information, contact AHCPR Public Affairs: Karen Carp, (301) 427-1858; Karen Migdail, (301) 427-1855 ; Salina Prasad, (301) 427-1864. To arrange interviews with Drs. Fine or Kapoor, please contact Amy Kemp, University of Pittsburgh Medical Center News Bureau, (412) 624-2607. To arrange interviews with Daniel E. Singer, M.D., and Christopher M. Coley, M.D., please contact Michelle Marcella, Massachusetts General Hospital Public Affairs Office, (617) 724-2755.