Quality of Care, Process, and Outcomes in Elderly Patients With Pneumonia

Meehan, Thomas P.; Fine, Michael J.; Krumholz, Harlan M.; Scinto, Jeanne D.; Galusha, Deron; Mockalis, Joyce T.; Weber, Georgina F.; Petrillo, Marcia K.; Houck, Peter M.; Fine, Jonathan

doi:10.1001/jama.1997.03550230056037

Cited by 744 publications

(412 citation statements)

References 17 publications

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“…4,8,[10][11][12][13][14][15][16] In a retrospective medical record review of Medicare patients, in-hospital mortality for PPI Classes 3, 4, and 5 was 2.8%, 8.5%, and 24.4%, respectively. 11 Twenty-three percent of this cohort was admitted from a nursing facility.…”

Section: Discussionmentioning

confidence: 99%

Community‐Acquired Pneumonia in Older Veterans: Does the Pneumonia Prognosis Index Help?

Mody

Sun

Bradley

2002

J American Geriatrics Society

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OBJECTIVES: Mortality rates from pneumonia increase steadily with age. Recently, a disease severity model (the Pneumonia Prognosis Index (PPI)) has been developed to predict mortality from community‐acquired pneumonia (CAP). PPI ranks severity of pneumonia from 1 to 5, with 5 being most severe. This retrospective study utilizes the PPI to address the prognosis of CAP in older adults. DESIGN: Retrospective review of medical charts. SETTING: Department of Veterans Affairs Medical Center. PARTICIPANTS: All adults aged 60 and older admitted to a Veterans Affairs Medical Center with CAP between January 1 and December 31, 1998. MEASUREMENTS: PPI was calculated using subjects' demographics, comorbidities, presenting symptoms, and laboratory measurements. RESULTS: Eighty‐two patients aged 60 and older were admitted with 101 episodes of CAP. The mean age ± standard deviation was 72 ± 9. Seventy‐four episodes were admitted from the emergency room, 20 from another hospital, seven from nursing homes, and five from outpatient clinics. Mean length of stay was 7.1 ± 6 days. Comorbid conditions included coronary artery disease, diabetes mellitus, congestive heart failure, neoplasm, stroke, and renal failure. Most episodes fell into higher PPI classes, with 20% in Class 3, 46% in Class 4, and 32% in Class 5. PPI score was significantly related to length of stay (P < .001), intensity of care (P < .0001), and presence of complications (P < .001). Mortality was 14% at 30 days: 0.5% in Class 3, 10.8% in Class 4, and 25% in Class 5. CONCLUSION: The PPI was effective in identifying older adults with CAP who were at risk of a poor outcome, but the practical utility of this index remains to be determined. Further prospective studies are required to elucidate the importance of comorbidities, severity at presentation, and premorbid functional status on clinical and functional outcomes of CAP in older adults. J Am Geriatr Soc 50:434–438, 2002.

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Section: Discussionmentioning

confidence: 99%

Community‐Acquired Pneumonia in Older Veterans: Does the Pneumonia Prognosis Index Help?

Mody

Sun

Bradley

2002

J American Geriatrics Society

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“…The evidence linking the pneumonia measures, for instance, to significant outcomes such as lower mortality or (rarely studied) better functional outcomes is extremely limited or nonexistent. 3,4 At the other end of the continuum are sweeping metrics such as risk-adjusted in-hospital mortality, which may be important and yet has 2 significant limitations. First, mortality rates in acute care are generally so low that this is not a useful outcome of interest for most clinical conditions.…”

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confidence: 99%

Hospital quality measurement— Perplexing for professionals, let alone for patients

O’Leary

Barnard

Noskin

2007

Journal of Hospital Medicine

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“…), y antes de ser enviado a planta médica que demora el tratamiento. Esta práctica se ha considerado adecuada como de 8 horas en el tiempo puerta-primera dosis de antibiótico y 24 horas en el hemocultivo (9,26). Algunos pacientes han tomado antibió-ticos antes de llegar al hospital.…”

Section: Resultsunclassified

Neumonía en el anciano mayor de 80 años con ingreso hospitalario

Garmendia

Haya

Claveras

et al. 2008

An. Med. Interna (Madrid)

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INTRODUCCIÓNLas neumonías son la primera causa de muerte de enfermedad infecciosa en el anciano. La mortalidad con tratamiento varía desde el 4% a más del 60% según el origen domicilio o residencias, las comorbilidades, edades, gérmenes causales, prontitud en la instauración del tratamiento, ventilación mecá-nica, antibiótico(s) utilizados, e intensidad de control de los mismos. La mortalidad según las edades varía, siendo elevada en los muy mayores. La escala de FINE (1) (PSI -Pneumonia severity index) es una nueva medida de juzgar la gravedad de las mismas. Nuevas recomendaciones y guías (2,11) hablan de la instauración de diferentes tratamientos en función de la gravedad, y el mantenimiento de los antibióticos durante un tiempo suficiente (IV inicial, luego oral en muchos casos), estas guías se han realizado por estudios prospectivos; pero en los [0212-7199 (2008) Conclusiones: a) MEDIN recibe pacientes más graves que NEUMO; b) mortalidad importante (16,7%) y progresiva en la escala FINE, a pesar de tratamiento correcto; c) la rápida administración de antibióticos no redujo la mortalidad; d) la mortalidad no varía aún con variantes de las Guías Clínicas; y c) hay areas de mejora en nuestros Servicios. 87.4 y, men at 84.5 y (p = 0.035). 12.4, 30% respectively Neumonía en el anciano mayor de 80 años con ingreso hospitalario

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Quality of Care, Process, and Outcomes in Elderly Patients With Pneumonia

Cited by 744 publications

References 17 publications

Community‐Acquired Pneumonia in Older Veterans: Does the Pneumonia Prognosis Index Help?

Community‐Acquired Pneumonia in Older Veterans: Does the Pneumonia Prognosis Index Help?

Hospital quality measurement— Perplexing for professionals, let alone for patients

Neumonía en el anciano mayor de 80 años con ingreso hospitalario

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