Processes and outcomes of care for patients with community-acquired pneumonia - Results from the Pneumonia Patient Outcomes Research Team (PORT) cohort study

Background: Although understanding the processes of care and medical outcom es for patients with community-acquired pneumonia is instrumental to improv ing the quality and cost-effectiveness of care for this illness, limited in formation is available on how physicians manage patients with this illness or on medical outcomes other than short-term mortality. Objectives: To describe the processes of care and to assess a broad range o f medical outcomes for ambulatory and hospitalized patients with community- acquired pneumonia. Methods: This prospective, observational study was conducted at 4 hospitals and 1 health maintenance organization in Pittsburgh, Pa, Boston, Mass, and Halifax, Nova Scotia. Data were collected via patient interviews and revie ws of medical records for 944 outpatients and 1343 inpatients with clinical and radiographic evidence of community-acquired pneumonia. Processes of ca re and medical outcomes were assessed 30 days after presentation. Results: Only 29.7% of outpatients had 1 or more microbiologic tests perfor med, and only 5.7% had an assigned microbiologic cause. Although 95.7% of i npatients had 1 or moro microbiologic tests performed, a cause was establis hed in only 29.6%. Six outpatients (0.6%) died, and 3 of these deaths were pneumonia related. Of surviving outpatients, 8.0% had 1 or more medical com plications. At 30 days, 88.9% (nonemployed) to 95.6% (employed) of the surv iving outpatients had returned to usual activities, yet 76.0% of outpatient s had 1 or more persisting pneumonia-related symptoms. Overall, 107 inpatie nts (8.0%) died, and 81 of these deaths were pneumonia related. Most surviv ing inpatients (69.0%) had 1 or more medical complications. At 30 days, 57. 3% (nonemployed) to 82.0% (employed) of surviving inpatients had returned t o usual activities, and 86.1% had 1 or more persisting pneumonia-related sy mptoms. Conclusions: In this study, conducted primarily at hospital sites with affi liated medical education training programs, virtually all outpatients and m ost inpatients had pneumonia of unknown cause. Although outpatients had an excellent prognosis, pneumonia-related symptoms often persisted at 30 days. Inpatients had substantial mortality, morbidity, and pneumonia-related sym ptoms at 30 days.