住院低风险社区获得性肺炎：结局与成本节约潜力

Department of Medicine, National University Hospital, Singapore.

Respirology. 1999 Sep;4(3):307-9. doi: 10.1046/j.1440-1843.1999.00197.x.

OBJECTIVE

In the USA, a group of low-risk patients with community-acquired pneumonia (CAP) with a low risk of mortality were identified and it was suggested that they may be treated as outpatients to save costs. We evaluated the outcome of these low-risk CAP patients that were hospitalized in our local setting, and gauged the number of such patients in order to estimate the potential cost-savings by treating them as out-patients, as well as the safety of such an approach.

METHODOLOGY

All patients with CAP admitted to the National University Hospital, Singapore, from 1 April to 1 November 1997 were enrolled into a prospective cohort study. Low-risk patients were identified, and their hospital outcomes were compared with the other patients. Hospitalization charges were obtained from the Finance Department.

RESULTS

There were 155 CAP patients (69 females and 86 males). The age was 56.6 +/- 22.2 years, ranging from 12 to 93 years old. The average hospital stay was 8.4 +/- 11 days. Mortality was 12.9%. There were 37 (24%) low-risk CAP patients, and there was no mortality in this group. No low-risk patient required mechanical ventilation. They had a significantly shorter hospital stay compared with high-risk patients. An identifiable organism was found in 27% of the low-risk CAP with only one patient having a positive blood culture. The average hospitalization charge for low-risk CAP patients was, as expected, significantly lower than for the high-risk patients, and was 11.9% of the total cost for hospitalized CAP patients.

CONCLUSION

Nearly one-quarter of our CAP admissions consisted of low-risk patients that had no mortality, and required a significantly shorter hospitalization period. The management of such patients who are young (< or = 50 years), and had no serious coexisting conditions in an out-patient setting, may lead to significant cost-savings as the average hospitalization charge was US$1295 and 11.9% of total hospitalization charges for CAP.

目的

在美国，已识别出一组社区获得性肺炎（CAP）死亡风险较低的低风险患者，并有人提出可将他们作为门诊患者治疗以节省费用。我们评估了在本地住院治疗的这些低风险CAP患者的治疗结果，统计了此类患者的数量，以估计将他们作为门诊患者治疗可能节省的费用以及这种治疗方法的安全性。

方法

1997年4月1日至11月1日期间入住新加坡国立大学医院的所有CAP患者均纳入一项前瞻性队列研究。识别出低风险患者，并将他们的住院治疗结果与其他患者进行比较。住院费用从财务部门获取。

结果

共有155例CAP患者（69例女性和86例男性）。年龄为56.6±22.2岁，范围为12至93岁。平均住院时间为8.4±11天。死亡率为12.9%。有37例（24%）低风险CAP患者，该组无死亡病例。没有低风险患者需要机械通气。与高风险患者相比，他们的住院时间明显更短。在27%的低风险CAP患者中发现了可识别的病原体，只有1例患者血培养呈阳性。正如预期的那样，低风险CAP患者的平均住院费用显著低于高风险患者，占CAP住院患者总费用的11.9%。