WHETHER TO TRANSFER - FACTORS ASSOCIATED WITH HOSPITALIZATION AND OUTCOME OF ELDERLY LONG-TERM-CARE PATIENTS WITH PNEUMONIA

OBJECTIVE: To determine factors associated with the decision to treat elderly long-term care patients with pneumonia in the hospital,vs in t he long-term care facility (LTCF) and factors associated with patient outcomes. DESIGN: Retrospective cohort study. SETTING: Hebrew Rehabili tation Center for Aged. PATIENTS: Nursing home residents who had an ep isode of pneumonia, defined as a new respiratory sign or symptom and a new infiltrate. MEASUREMENTS AND MAIN RESULTS: The majority of the 31 6 pneumonia episodes (78%) were managed in the LTCF, most (77%) with o ral antibiotics. Both patient-related factors, such as elevated respir atory rate, and non-patient-related factors, such as evening evaluatio n, were associated with hospitalization, No patient who had a do-not-h ospitalize (DNH) order was hospitalized. Equal proportions of patients given LTCF therapy (87%) and hospital therapy (88%) survived, Elevate d respiratory rate was associated with dying from pneumonia in the LTC F but not in the hospital. Dependent functional status was associated with dying from pneumonia in both sites. CONCLUSIONS: Many episodes of pneumonia can be managed in the LTCF with oral antibiotics, Because, in the absence of DNH orders, both patient-related and non-patient-rel ated factors are associated with hospital transfer, discussion regardi ng preferences for hospitalization should occur prior to the developme nt of an acute illness, A high respiratory rate may be a good marker f or those LTCF patients requiring hospitalization. Dependent functional status may be a good marker for those LTCF patients unlikely to benef it from hospital transfer.