Frequency of subspecialty physician care for elderly patients with community-acquired pneumonia

Study objectives: Specialty societies have developed practice guidelines fo r the treatment of community-acquired pneumonia (CAP). To aid in adapting s pecialty recommendations for a pneumonia practice guideline at Intermountai n Health Care, we investigated which physicians care for pneumonia patients in Utah. We wanted to understand who provides pneumonia care so as to appr opriately target the guideline and design tools for implementation. Design: Retrospective observational study. Setting: Inpatient and outpatient multicenter, Patients: The study population comprised 13,919 (16,420 episodes of pneumon ia) Utah resident Medicare beneficiaries greater than or equal to 65 years of age who had CAP. Nursing home residents were excluded, Measurements: We used Health Care Financing Administration billing records from 1993 through 1995 to identify the physicians involved in the care of p neumonia patients by self-designated specialty. We Linked patterns of physi cian involvement to age, sex, residential zip code, 30-day mortality rate, and whether or not the patient was hospitalized. Results: The involvement of a pneumonia specialist was limited to 11.7% of episodes, with involvement of a pulmonary specialist in 10.6%, an infectiou s disease (ID) specialist in 0.9%, and the involvement of both specialties in 0.2% of episodes, Greater specialty involvement was observed in episodes resulting in pneumonia hospitalization (20.0% vs 8.6%, respectively; p < 0 .0001), death (20.5% vs 11.2%, respectively; p < 0.0001), and episodes amon g patients with urban county residential zip codes (13.7% vs 7.5%, respecti vely; p < 0.0001), Conclusion: Most episodes of pneumonia, including those with serious conseq uences, are treated by primary care physicians with little or no involvemen t from pulmonary ol ID specialists. It is not known whether greater or less er specialty physician involvement would change pneumonia costs or clinical outcomes.