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Evaluation 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
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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