Pneumonia can be treated effectively in nursing homes

There may be no advantage to taking nursing home residents to hospital for treatment of pneumonia.

They can do as well if they receive the same medical treatment at their residence, a study conducted by McMaster University researchers and funded by the Canadian Institutes of Health Research (CIHR) has shown.

When nursing home residents are routinely hospitalized with pneumonia, they may become susceptible to other health risks, including a reduction in their quality of life and a decline in functional health. The transfers also place a major burden on the healthcare system in emergency departments and hospital wards, particularly during influenza season.

In contrast, treatment at home can significantly save health care costs, estimated to be $1,200 per patient treated for pneumonia.

"The data have important implications for the delivery of health care services for both long-term care facilities and acute care hospitals," says Mark Loeb, principal investigator and professor of medicine and an infectious disease expert. "We estimate that implementation of the clinical pathway could result in a savings of $84 million Canadian annually. In the U.S., the cost savings could approximate $831 million annually."

Dr. Mark Loeb and his colleagues at McMaster University's Michael G. DeGroote School of Medicine conducted a randomized controlled trial of 680 residents in 22 nursing homes in the Hamilton area. They assessed hospital admissions, length of hospital stay, mortality, quality of life, functional status and cost.

They found that by following a defined standard of care to treat pneumonia, essentially bringing hospital care to the nursing home, hospitalizations were reduced by over half - - 10 percent of residents versus 22 percent in the group who had usual care. There was a substantial cost savings of more than $1,200 per resident, with no increase in mortality.

The defined clinical pathway included the use of oral antibiotics, portable chest x-rays, oxygen saturation monitoring, rehydration and close monitoring by a research nurse.

"The results of Dr. Loeb's study point to ways seniors can receive the best available health care with the least possible disruption at a stage in their lives when any disruption can be a significant source of stress," said Dr. Morris Barer, scientific director of the CIHR Institute of Health Services and Policy Research. "This study is a compelling example of how evidence gained through health research can save money and strengthen our health care system."

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