MEASURING SYMPTOMATIC AND FUNCTIONAL RECOVERY IN PATIENTS WITH COMMUNITY-ACQUIRED PNEUMONIA

OBJECTIVE: To determine the rates of resolution of symptoms and return to premorbid health status and assess the association of these outcom es with health care utilization in patients with community-acquired pn eumonia. DESIGN: A prospective, multicenter cohort study. SETTING: Inp atient and outpatient facilities at three university hospitals, one co mmunity hospital, and one staff-model health maintenance organization. PATIENTS: Five hundred seventy-six adults (aged greater than or equal to 18 years) with clinical and radiographic evidence of pneumonia, ju dged by a validated pneumonia severity index to be at low risk of dyin g. MEASUREMENTS AND MAIN RESULTS: The presence and severity of five sy mptoms (cough, fatigue, dyspnea, sputum, and chest pain) were recorded through questionnaires administered at four time points: 0, 7, 30, an d 90 days from the time of radiographic diagnosis of pneumonia, A summ ary symptom score was tabulated as the sum of the five individual seve rity scores. Patients also provided responses to the Medical Outcomes Study 36-Item Short Form Health Survey (SF-36) and reported the number of and reason for outpatient physician visits. Symptoms and health st atus 30 days before pneumonia onset (prepneumonia) were obtained at th e initial interview. All symptoms, except pleuritic chest pain, were s till commonly reported at 30 days, and the prevalence of each symptom at 90 days was still nearly twice prepneumonia levels. Physical health measures derived from the SF-36 Form declined significantly at presen tation but continued to improve over all three follow-up time periods. Patients with elevated symptom scores at day 7 or day 30 were signifi cantly more likely to report pneumonia-related ambulatory care visits at the subsequent day 30 or day 90 interviews, respectively, CONCLUSIO NS: Disease-specific symptom resolution and recovery of the premorbid physical health status requires more than 30 days for many patients wi th pneumonia. Delayed resolution of symptoms is associated with increa sed utilization of outpatient physician visits.