Process of care performance, patient characteristics, and outcomes in elderly patients hospitalized with community-acquired or nursing home-acquired pneumonia

Study objectives: To compare process of care performance, patient character istics, and outcomes in a contemporary cohort of elderly (greater than or e qual to 65 years) patients hospitalized with community-acquired pneumonia ( CAP) or with nursing home-acquired pneumonia (NHAP), Design: State-nide retrospective cohort study. Setting: Thirty-four acute-care hospitals in Connecticut. Patients: Elderly Medicare patients hospitalized in 1995-1996 with CAP (1,1 31) or with NHAP (528), Measurements: Antibiotic administration within 8 h of hospital arrival, blood culture collection within 24 h of hospital arriv al, oxygenation assessment within 24 h of hospital arrival, demographic and clinical characteristics, in-hospital complications, mortality, and length of stay. Results: Process of care performance rates for patients with CAP and NHAP w ere equivalent for antibiotic administration within 8 h of hospital arrival (76.8% vs 76,3%, respectively; p = 0.82), blood culture collection within 24 h of hospital arrival (78.1% vs 81.1%, respectively; p = 0.31), and oxyg enation assessment within 24 h of hospital arrival (94.7% vs 95.3%, respect ively; p = 0.70), Patients with CAP were younger than those with NHAP (medi an age, 80 vs 84 years, respectively p < 0,001), had less cerebrovascular d isease (16.8% vs 34.7%, respectively; p less than or equal to 0,001), and l ower mortality risk scores at hospital presentation (median, 100 vs 137, re spectively; p less than or equal to 0.001) than patients with NHAP, The med ian length of stay was equivalent (7 clays), but the in-hospital mortality rate was lower in patients with CAP than in patients with NHAP (8.0% vs 18. 6%, respectively; p less than or equal to 0,001), Conclusion: initial hospital processes of care are performed at the same ra te in patients hospitalized,vith CAP or NHAP. However, patients with CAP ar e younger, are less acutely and chronically ill, and have lower in-hospital mortality rates than patients with NHAP.