社区获得性或养老院获得性肺炎住院老年患者的护理过程表现、患者特征及预后

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

作者信息

Meehan T P, Chua-Reyes J M, Tate J, Prestwood K M, Scinto J D, Petrillo M K, Metersky M L

机构信息

Department of Medicine, Yale University School of Medicine, New Haven, CT 06457, USA.

出版信息

Chest. 2000 May;117(5):1378-85. doi: 10.1378/chest.117.5.1378.

DOI:10.1378/chest.117.5.1378

PMID:10807825

Abstract

STUDY OBJECTIVES

To compare process of care performance, patient characteristics, and outcomes in a contemporary cohort of elderly (> or = 65 years) patients hospitalized with community-acquired pneumonia (CAP) or with nursing home-acquired pneumonia (NHAP).

DESIGN

State-wide retrospective cohort study.

SETTING

Thirty-four acute-care hospitals in Connecticut.

PATIENTS

Elderly Medicare patients hospitalized in 1995-1996 with CAP (1,131) or with NHAP (528).

MEASUREMENTS

Antibiotic administration within 8 h of hospital arrival, blood culture collection within 24 h of hospital arrival, 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 were 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 oxygenation assessment within 24 h of hospital arrival (94.7% vs 95. 3%, respectively; p = 0.70). Patients with CAP were younger than those with NHAP (median age, 80 vs 84 years, respectively; p < 0. 001), had less cerebrovascular disease (16.8% vs 34.7%, respectively; p < or = 0.001), and lower mortality risk scores at hospital presentation (median, 100 vs 137, respectively; p < or = 0. 001) than patients with NHAP. The median length of stay was equivalent (7 days), but the in-hospital mortality rate was lower in patients with CAP than in patients with NHAP (8.0% vs 18.6%, respectively; p < or = 0.001).

CONCLUSION

Initial hospital processes of care are performed at the same rate in patients hospitalized with CAP or NHAP. However, patients with CAP are younger, are less acutely and chronically ill, and have lower in-hospital mortality rates than patients with NHAP.

摘要

研究目的

比较当代老年（≥65岁）社区获得性肺炎（CAP）或养老院获得性肺炎（NHAP）住院患者的护理过程表现、患者特征及预后。

设计

全州范围的回顾性队列研究。

地点

康涅狄格州的34家急症护理医院。

患者

1995 - 1996年因CAP（1131例）或NHAP（528例）住院的老年医疗保险患者。

测量指标

入院8小时内给予抗生素、入院24小时内采集血培养、入院24小时内进行氧合评估、人口统计学和临床特征、院内并发症、死亡率及住院时间。

结果

CAP和NHAP患者在入院8小时内给予抗生素（分别为76.8%和76.3%；p = 0.82）、入院24小时内采集血培养（分别为78.1%和81.1%；p = 0.31）以及入院24小时内进行氧合评估（分别为94.7%和95.3%；p = 0.70）方面的护理过程表现率相当。CAP患者比NHAP患者年轻（中位年龄分别为80岁和84岁；p < 0.001），脑血管疾病较少（分别为16.8%和34.7%；p ≤ 0.001），入院时死亡风险评分较低（中位值分别为100和137；p ≤ 0.001）。中位住院时间相当（7天），但CAP患者的院内死亡率低于NHAP患者（分别为8.0%和18.6%；p ≤ 0.001）。