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 outcomes with health care utilization in patients with community‐acquired pneumonia. DESIGN: A prospective, multicenter cohort study. SETTING: Inpatient and outpatien...

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Bibliographic Details
Published in:Journal of general internal medicine : JGIM 1997-07, Vol.12 (7), p.423-430
Main Authors: Metlay, Joshua P., Fine, Michael J., Schulz, Richard, Marrie, Thomas J., Coley, Christopher M., Kapoor, Wishwa N., Singer, Daniel E.
Format: Article
Language:English
Subjects:
Adult
Aged
Ambulatory care
Ambulatory Care - statistics & numerical data
Bacterial diseases
Bacterial diseases of the respiratory system
Biological and medical sciences
Clinical outcomes
Cohort analysis
Community-Acquired Infections - diagnosis
Community-Acquired Infections - physiopathology
Community-Acquired Infections - therapy
Female
Health maintenance organizations
Health Services Accessibility
Health services utilization
Health Status
Health surveys
HMOs
Hospitals
Hospitals, University
Human bacterial diseases
Humans
Illnesses
Infectious diseases
Internal medicine
Male
Medical sciences
Medicine
Middle Aged
Mortality
Multivariate Analysis
Nova Scotia
Original
Patients
Pneumonia
Pneumonia - diagnosis
Pneumonia - physiopathology
Pneumonia - therapy
Practice Patterns, Physicians
Prognosis
Prospective Studies
Questionnaires
Reproducibility of Results
Scholarships & fellowships
Severity of Illness Index
Surveys and Questionnaires
Treatment Outcome
United States
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Summary:OBJECTIVE: To determine the rates of resolution of symptoms and return to premorbid health status and assess the association of these outcomes with health care utilization in patients with community‐acquired pneumonia. DESIGN: A prospective, multicenter cohort study. SETTING: Inpatient and outpatient facilities at three university hospitals, one community hospital, and one staff‐model health maintenance organization. PATIENTS: Five hundred seventy‐six adults (aged ≥ 18 years) with clinical and radiographic evidence of pneumonia, judged by a validated pneumonia severity index to be at low risk of dying. MEASUREMENTS AND MAIN RESULTS: The presence and severity of five symptoms (cough, fatigue, dyspnea, sputum, and chest pain) were recorded through questionnaires administered at four time points: 0, 7, 30, and 90 days from the time of radiographic diagnosis of pneumonia. A summary symptom score was tabulated as the sum of the five individual severity 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 status 30 days before pneumonia onset (prepneumonia) were obtained at the initial interview. All symptoms, except pleuritic chest pain, were still 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 presentation but continued to improve over all three follow‐up time periods. Patients with elevated symptom scores at day 7 or day 30 were significantly more likely to report pneumonia‐related ambulatory care visits at the subsequent day 30 or day 90 interviews, respectively. CONCLUSIONS: Disease‐specific symptom resolution and recovery of the premorbid physical health status requires more than 30 days for many patients with pneumonia. Delayed resolution of symptoms is associated with increased utilization of outpatient physician visits. KEY WORDS: pneumonia; health status; outcomes assessment; questionnaires.
ISSN:0884-8734
1525-1497
DOI:10.1046/j.1525-1497.1997.00074.x