Showing papers by "Michael J. Fine published in 1998"
TL;DR: Estimates of time to stability in pneumonia and explicit criteria for defining stability can provide an evidence-based estimate of optimal length of stay, and outline a clinically sensible approach to improving the efficiency of inpatient management are outlined.
Abstract: Context.—Many groups have developed guidelines to shorten hospital length of
stay in pneumonia in order to decrease costs, but the length of time until
a patient hospitalized with pneumonia becomes clinically stable has not been
established.Objective.—To describe the time to resolution of abnormalities in vital signs,
ability to eat, and mental status in patients with community-acquired pneumonia
and assess clinical outcomes after achieving stability.Design.—Prospective, multicenter, observational cohort study.Setting.—Three university and 1 community teaching hospital in Boston, Mass,
Pittsburgh, Pa, and Halifax, Nova Scotia.Patients.—Six hundred eighty-six adults hospitalized with community-acquired pneumonia.Main Outcome Measures.—Time to resolution of vital signs, ability to eat, mental status, hospital
length of stay, and admission to an intensive care, coronary care, or telemetry
unit.Results.—The median time to stability was 2 days for heart rate (≤100 beats/min)
and systolic blood pressure (≥90 mm Hg), and 3 days for respiratory rate
(≤24 breaths/min), oxygen saturation (≥90%), and temperature (≤37.2°C
[99°F]). The median time to overall clinical stability was 3 days for
the most lenient definition of stability and 7 days for the most conservative
definition. Patients with more severe cases of pneumonia at presentation took
longer to reach stability. Once stability was achieved, clinical deterioration
requiring intensive care, coronary care, or telemetry monitoring occurred
in 1% of cases or fewer. Between 65% to 86% of patients stayed in the hospital
more than 1 day after reaching stability, and fewer than 29% to 46% were converted
to oral antibiotics within 1 day of stability, depending on the definition
of stability.Conclusions.—Our estimates of time to stability in pneumonia and explicit criteria
for defining stability can provide an evidence-based estimate of optimal length
of stay, and outline a clinically sensible approach to improving the efficiency
of inpatient management.
483 citations
TL;DR: Variations in antimicrobial prescribing practices by treatment site exist for outpatients and inpatients with community-acquired pneumonia, and patients treated at institutions with the lowest antimicrobial costs do not demonstrate worse medical outcomes.
101 citations
TL;DR: Processes and costs of care for community-acquired pneumonia varied by provider characteristics, but neither mortality nor readmission rates did.
Abstract: Objectives.The authors describe the relation of provider characteristics to processes, costs, and outcomes of medical care for elderly patients hospitalized for community-acquired pneumonia.Methods.Using Medicare claims data, Medicare beneficiaries discharged from Pennsylvania hospitals during 1
84 citations
TL;DR: A small proportion of patients with CAP initially treated in the outpatient setting are subsequently hospitalized, and such patients face a higher risk of delayed recovery or death, which seems a reasonable screening tool for potentially unsatisfactory quality of care.
78 citations
TL;DR: A recent small-scale intervention trial demonstrates that the pneumonia PORT rule can reduce admissions for adult patients with CAP without compromising patient outcomes.
42 citations
TL;DR: Patients diagnosed with E. coli pneumonia are frequently bacteremic and are older than patients with pneumonia due to other etiologies, and more likely to be female, from a nursing home and severely ill, and are more severely ill as measured by a validated pneumonia specific severity of illness scoring measure.
27 citations
TL;DR: Patients with community-acquired pneumonia on an outpatient basis with a high risk of 30-day mortality are treated with antibiotic therapy with erythromycin or doxycycline, which is generally effective.
Abstract: Recently published guidelines permit the decision to treat patients with community-acquired pneumonia on an outpatient basis to be made more confidently than in the past. In most cases, the risk of 30-day mortality can be evaluated without extensive laboratory testing. Antibiotic therapy with erythromycin or doxycycline is generally effective.
12 citations