TUESDAY, June 6, 2006 (HealthDay News) -- A program for monitoring and treating nursing home residents for pneumonia saved a lot of money by keeping them out of the hospital, a new Canadian study finds.
Pneumonia and other respiratory tract infections are common in nursing homes. Many patients are sent to emergency rooms for treatment, the study said, but a program that had specially trained nurses monitor and guide treatment of the patients more than halved the rate of hospitalization.
The program saved an average of $1,000 per patient in U.S. dollars, said Dr. Mark Loeb, a professor of pathology and molecular medicine at McMaster University in Hamilton, Ontario. The overall U.S. annual savings would be $800 million, if every nursing home in the United States adopted the program, Loeb estimated.
The findings appear in the June 7 issue of the Journal of the American Medical Association.
The study included 680 older people diagnosed with respiratory tract infections in 22 Canadian nursing homes. Half of them got the usual treatment, and 22 percent of them eventually were sent to hospitals. The other half got what amounted to the same sort of treatment given in hospitals -- chest X-rays, antibiotics, oxygen blood level monitoring, close attention by trained nurses -- and only 10 percent of them wound up in hospitals.
And, Loeb noted, "there was no difference in the death rate in the two groups."
Widespread adoption of the monitoring program "would benefit the acute-care system," Loeb said. "It would reduce congestion in emergency rooms."
The program would also improve the response to the feared pandemic of avian flu, Loeb said, and the extra cost of training nurse practitioners would be more than offset by the savings in hospital costs.
The report drew limited praise from Dr. David Dosa, an assistant professor of medicine at Brown University and an expert on the issue. "It clearly suggests that hospitalizations and their resulting costs can be reduced when well
thought-out guidelines are in place and are utilized," he said.
However, Dosa said, "there are a number of key limitations to this paper, however, that should temper excitement."
One limitation is the availability of the nurses required for the program, Dosa said. Many hospitalizations now occur after-hours or on weekends, when skilled nursing home personnel are not available, he said. Once in the hospital, the patients are kept there, even though they could be returned to the nursing home after basic treatment.
Other problems, Dosa said, are that "nursing homes in the United States are understaffed and poorly reimbursed, particularly for skilled, acute care," and there are no incentives, financial or otherwise, for them to keep patients from going to the hospital.
Nevertheless, Loeb said, "what we are saying is that using this pathway can reduce hospitalizations by more than 50 percent."
More information
An overview of pneumonia and other respiratory infections is offered by the National Library of Medicine.
