The American Journal of Medicine
Volume 121, Issue 10 , Pages 845-852 , October 2008

Declining Length of Hospital Stay for Pneumonia and Postdischarge Outcomes

  • Alberto Capelastegui, MD, PhD

      Affiliations

    • Pneumology Service, Galdakao Hospital, Galdakao, Bizkaia, Spain
    • Corresponding Author InformationRequests for reprints should be addressed to Alberto Capelastegui, MD, PhD, Service of Pneumology, Hospital de Galdakao-Usansolo, E-48960 Galdakao, Bizkaia, Spain
    • ,
  • Pedro P. España, MD

      Affiliations

    • Pneumology Service, Galdakao Hospital, Galdakao, Bizkaia, Spain
    • ,
  • José M. Quintana, MD, PhD

      Affiliations

    • Research Unit-CIBER Epidemiología y Salud Pública, Galdakao Hospital, Galdakao, Bizkaia, Spain
    • ,
  • Maitane Gallarreta, MD

      Affiliations

    • Department of Emergency Medicine, Galdakao Hospital, Galdakao, Bizkaia, Spain
    • ,
  • Inmaculada Gorordo, MD

      Affiliations

    • Pneumology Service, Galdakao Hospital, Galdakao, Bizkaia, Spain
    • ,
  • Cristobal Esteban, MD

      Affiliations

    • Pneumology Service, Galdakao Hospital, Galdakao, Bizkaia, Spain
    • ,
  • Isabel Urrutia, MD, PhD

      Affiliations

    • Pneumology Service, Galdakao Hospital, Galdakao, Bizkaia, Spain
    • ,
  • Amaia Bilbao, MSc

      Affiliations

    • Basque Foundation for Health Innovation and Research (BIOEF)-CIBER Epidemiología y Salud Pública, Sondika, Bizkaia, Spain

References 

  1. Fry AM, Shay DK, Holman RC, et al. Trends in hospitalization for pneumonia among persons aged 65 years or older in the United States, 1988-2002. JAMA. 2005;294:2712–2719
  2. Kaplan V, Angus DC, Griffin MF, et al. Hospitalized community-acquired pneumonia in the elderly: age- and sex-related patterns of care and outcome in the United States. Am J Respir Crit Care Med. 2002;165:766–772
  3. Marrie TJ, Lau CY, Wheeler SI, et al. A controlled trial of a critical pathway for treatment of community-acquired pneumonia. JAMA. 2000;283:749–755
  4. McCormick D, Fine MJ, Coley CM, et al. Variation in length of hospital stay in patients with community-acquired pneumonia: are shorter stays associated with worse medical outcomes?. Am J Med. 1999;107:5–12
  5. Fine MJ, Pratt HM, Obrosky DS, et al. Relation between length of hospital stay and cost of care for patients with community-acquired pneumonia. Am J Med. 2000;109:434–436
  6. Fine MJ, Auble TE, Yealy DM, et al. A prediction rule to identify low-risk patients with community-acquired pneumonia. N Engl J Med. 1997;336:243–250
  7. Weingarten SR, Riedinger MS, Hobson P, et al. Evaluation of a pneumonia practice guideline in an interventional trial. Am J Respir Crit Care Med. 1996;153:1110–1115
  8. Battleman DS, Callahan M, Howard TT. Rapid antibiotic delivery and appropriate antibiotic selection reduce length of hospital stay of patients with community-acquired pneumonia. Arch Intern Med. 2002;162:682–688
  9. Baker DW, Einstadter D, Thomas C, et al. Mortality trends during a program that publicly reported hospital performance. Med Care. 2002;40:879–890
  10. Baker DW, Einstadter D, Husak SS, et al. Trends in post-discharge mortality and readmissions: has length of stay declined too far ?. Arch Intern Med. 2004;164:538–544
  11. Siegel RE. How long a stay in the hospital is needed for patients with community-acquired pneumonia?. Am J Med. 2000;109:434–436
  12. Ramirez JA, Vargas S, Ritter GW, et al. Early switch from intravenous to oral antibiotics and early hospital discharge. Arch Intern Med. 1999;159:2449–2454
  13. Nathan RV, Rhew DC, Murray C, et al. In-hospital observation after antibiotic switch in pneumonia: a national evaluation. Am J Med. 2006;119:512–518
  14. Kosecoff J, Kahn KL, Rogers WH, et al. Prospective payment system and impairment at discharge: the “quicker-and sicker” story revisited. JAMA. 1990;264:1980–1983
  15. Kahn KL, Keeler EB, Sherwood MJ, et al. Comparing outcomes of care before and after implementation of the DRG-based prospective payment system. JAMA. 1990;264:1984–1988
  16. España PP, Capelastegui A, Quintana JM, et al. A prediction rule to identify allocation of inpatient care in community-acquired pneumonia. Eur Respir J. 2003;21:695–701
  17. Niederman MS, Mandell LA, Anzueto A, et al. Guidelines for the management of adults with community-acquired pneumonia (Diagnosis, assessment of severity, antimicrobial therapy, and prevention). Am J Respir Crit Care Med. 2001;163:1730–1754
  18. Menendez R, Torres A, Zalacain R, et al. Risk factors of treatment failure in community-acquired pneumonia: implications for disease outcome. Thorax. 2004;59:960–965
  19. Halm EA, Fine MJ, Kapoor WN, et al. Instability on hospital discharge and the risk of adverse outcomes in patients with pneumonia. Arch Intern Med. 2002;162:1278–1284
  20. Hanley JA, McNeil BJ. The meaning and use of the area under a receiver operating characteristic (ROC) curve. Radiology. 1982;143:29–36
  21. Fishbane S, Niederman MS, Daly C, et al. The impact of standardized order sets and intensive clinical case management on outcomes in community-acquired pneumonia. Arch Intern Med. 2007;167:1664–1669
  22. Battleman DS, Callahan M, Thaler HY. Rapid antibiotic delivery and appropriate antibiotic selection reduce length of hospital stay of patients with community-acquired pneumonia. Arch Intern Med. 2002;162:682–688
  23. Yealy DM, Auble TE, Stone RA, et al. Effect of increasing the intensity of implementing pneumonia guidelines: a randomized, controlled trial. Ann Intern Med. 2005;143:881–894
  24. Capelastegui A, España PP, Quintana JM, et al. Improvement of process-of-care and outcomes after implementing a guideline for management of community-acquired pneumonia: a controlled before-and-after study. Clin Infect Dis. 2004;39:955–963
  25. Sin DS, Tu JV. Are elderly patients with obstructive airway disease being prematurely discharged?. Am J Respir Crit Care Med. 2000;161:1513–1517
  26. Fine MJ, Stone RA, Lave JR, et al. Implementation of an evidence-based guideline to reduce duration of intravenous antibiotic therapy and length of stay for patients hospitalized with community-acquired pneumonia: a randomized controlled trial. Am J Med. 2003;115:343–351
  27. Mandell LA, Wunderink RG, Anzueto A, et al. Infectious Diseases Society of America/American thoracic Society consensus guidelines on the management of community-acquired pneumonia. Clin Infect Dis. 2007;44:S27–S72
  28. Halm EA, Switzer GE, Mittmen BS, et al. What factors influence physicians' decisions to switch from intravenous to oral antibiotics for community-acquired pneumonia?. J Gen Intern Med. 2001;16:599–605
  29. Lim WS, Van der Eerden MM, Laing R, et al. Defining community-acquired pneumonia severity presentation to hospital: an international derivation and validation study. Thorax. 2003;58:377–382

 Sources of support: none.

PII: S0002-9343(08)00492-0

doi: 10.1016/j.amjmed.2008.05.010

The American Journal of Medicine
Volume 121, Issue 10 , Pages 845-852 , October 2008

Article Tools

* Image Usage & Resolution