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Agency for Healthcare Research Quality

Pneumonia: More Patients May Be Treated at Home

Research Findings for Consumers


A promising new model for doctors developed by U.S. and Canadian researchers could lead to more patients being treated for pneumonia in the comfort of their own homes as safely and as effectively as if they were hospitalized, according to new research supported by the Federal Government's Agency for Health Care Policy and Research (AHCPR). The model—a clinical algorithm—can help doctors quickly and easily determine a patient's risk level, which is essential for deciding where treatment should take place and the type of therapy to be used.

Although pneumonia—a disease characterized by a bacterial or viral infection of the lungs—can be deadly, research has shown that the majority of patients are low-risk, meaning that they are in little danger of dying from the disease or of suffering serious consequences because of it.

Some patients already being treated in the hospital develop pneumonia.However, this research addresses the vast majority of pneumonia cases, patients not already hospitalized. About 4 million Americans a year develop this "community-acquired" pneumonia and 600,000 of these, or 15 percent, are hospitalized.

Although about 85 percent of pneumonia cases currently are treated outside the hospital, medical experts believe that an even higher percentage are eligible for outpatient care, and others could be hospitalized just for short periods. Treating more pneumonia patients at home also could help lower the cost of care. Inpatient treatment of pneumonia costs an estimated 10 to 15 times as much as outpatient care.

The problem is that doctors currently do not have science-based criteria to guide their decisions for admitting pneumonia patients. Part of the solution, researchers believe, may lie in this new model, which helps physicians identify pneumonia patients who do not need intensive treatment by accurately estimating their progress, or prognosis, from basic medical information.

To ensure the accuracy of the algorithm, the researchers tested it using data on thousands of pneumonia patients, including roughly 2,300 individuals in Pittsburgh, Boston, and Halifax, Nova Scotia, who were treated at home or in the hospital. If the prediction model had been available to doctors in those three cities, roughly a quarter to nearly one-third of the hospitalized patients could have been assigned outpatient care, and slightly over a tenth to almost one-fifth could have been kept only briefly for observation instead of having a longer stay.

What Patients Prefer

Most of the low-risk patients in the study who were surveyed, including those hospitalized for initial treatment, said they generally preferred home-based care. But the researchers found that patients usually are not asked where and how they would like their pneumonia to be treated. Of the doctors from the three-city study who were surveyed, 83 percent said that they alone made the decisions for outpatients, and 72 percent said they did so for the inpatients. A number of factors weigh against home care, such as the lack of a family caregiver, limited availability of home nursing services, inability to drink fluids and take medication by mouth, and certain severe medical conditions.

About the Study

These findings are from a recently completed, 5-year study of variations and outcomes in pneumonia care. The research is part of a series of studies on the quality, effectiveness, and cost-effectiveness of current therapies for treating some of the most common and costly medical conditions in the United States. The project is supported by AHCPR—the U.S. Department of Health and Human Services agency spearheading Federal efforts to improve the quality of American medical care. The study was directed by Wishwa N. Kapoor, M.D., M.P.H., from the University of Pittsburgh School of Medicine.

Printed copies of Pneumonia: More Patients May Be Treated at Home (AHCPR Pub. No. 97-R030), as well as a fact sheet for clinicians, Pneumonia: New Prediction Model Proves Promising (AHCPR Pub. No. 97-R031), are available by calling the AHCPR Publications Clearinghouse at 800-358-9295. From outside the United States, call (703) 437-2078.

AHCPR Publication No. 97-R030
Current as of January 1997

Internet Citation:

Pneumonia: More Patients May Be Treated at Home. AHCPR Publication No. 97-R030, January 1997. Agency for Health Care Policy and Research, Rockville, MD.


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