Revista Científica de la Sociedad Española de Medicina de Urgencias y Emergencias
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1er cuartil (5 de 32)
Emergency Medicine
Resumen
< ReturnEvaluation of a multidisciplinary alternative hospitalization model in comparison with conventional hospitalization for patients with community-acquired pneumonia
Llorens Soriano P, Murcia-Zaragoza J, Sánchez-Payá J, Laghzaoui F, Reus S, Carratalá-Perales JM, Merino E, Gómez Izquierdo R, Portilla J
Servicio de Urgencias-Unidad de Corta Estancia. Servicio de Medicina Preventiva. Unidad de Enfermedades Infecciosas. Unidad de Hospitalización a Domicilio. Hospital General Universitario de Alicante. Alicante, Spain.
Objective: To compare duration of hospital stay and mortality between conventional
hospitalization and an alternative hospital care model for patients with communityacquired
pneumonia (CAP).
Patients and methods: Prospective, nonrandomized study including all patients with
CAP treated in our hospital’s emergency department (ED) in 1 year. We recorded
information on sociodemographic variables, comorbidity, clinical condition, and
laboratory findings. The Pneumonia Severity Index (PSI) and the Barthel score were also
recorded on admission to the ED. A care model (alternative or conventional
hospitalization) was assigned without randamization on admission. The alternative
model consisted of admission to a short-stay unit in the ED, and follow-up on discharge
in the day hospital of the infectious diseases department or at home by the home
hospitalization staff. Outcome measures were duration of hospital stay and 30-day
mortality.
Results: Of a total of 550 patients, 425 (77.2%) were admitted; 252 received
conventional hospital care and 130 were treated under the alternative model. Those
assigned to the alternative model were older (mean age of 69 years vs. 62.7 years,
P<.001), had greater functional deficits (47% vs 23.8%; P<.001), and a higher PSI (PSI of
IV or higher, 61.5% vs 36.9%; P<.001). The duration of hospital stay was shorter under
the alternative model (2.5 days vs 9.6 days, P<.001) and 30-day mortality was lower
(3.9% vs 11.2%, P<.05; relative risk, 0.3 [95% confidence interval, 0.1-0.8]).
Conclusions: This alternative model of hospital care for the management of CAP allows
hospital stay to be shortened and it is associated with lower mortality.
hospitalization and an alternative hospital care model for patients with communityacquired
pneumonia (CAP).
Patients and methods: Prospective, nonrandomized study including all patients with
CAP treated in our hospital’s emergency department (ED) in 1 year. We recorded
information on sociodemographic variables, comorbidity, clinical condition, and
laboratory findings. The Pneumonia Severity Index (PSI) and the Barthel score were also
recorded on admission to the ED. A care model (alternative or conventional
hospitalization) was assigned without randamization on admission. The alternative
model consisted of admission to a short-stay unit in the ED, and follow-up on discharge
in the day hospital of the infectious diseases department or at home by the home
hospitalization staff. Outcome measures were duration of hospital stay and 30-day
mortality.
Results: Of a total of 550 patients, 425 (77.2%) were admitted; 252 received
conventional hospital care and 130 were treated under the alternative model. Those
assigned to the alternative model were older (mean age of 69 years vs. 62.7 years,
P<.001), had greater functional deficits (47% vs 23.8%; P<.001), and a higher PSI (PSI of
IV or higher, 61.5% vs 36.9%; P<.001). The duration of hospital stay was shorter under
the alternative model (2.5 days vs 9.6 days, P<.001) and 30-day mortality was lower
(3.9% vs 11.2%, P<.05; relative risk, 0.3 [95% confidence interval, 0.1-0.8]).
Conclusions: This alternative model of hospital care for the management of CAP allows
hospital stay to be shortened and it is associated with lower mortality.
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