Community-acquired pneumonia in patients receiving home care

To describe the features of community-acquired pneumonia (CAP) requiring hospitalization in subjects receiving home care.

Prospective study from November 15, 2000, to November 14, 2002.

Six hospitals in the Edmonton, Canada, area.

Two thousand four hundred sixty-four subjects aged 17 years and older with CAP, 21.9% of whom were receiving home care.

Pneumonia attack rates, demographic features, severity of illness, medication, length of stay, mortality, in hospital complications, and time to achieve physiological stability.

The overall rate of CAP requiring a visit to an emergency department in home care recipients was 25 per 1,000 person years, 90.8% of whom were admitted to the hospital for treatment. Patients who were receiving home care at the time of admission were older and less likely to be current tobacco smokers, had higher in-hospital mortality (11%) and a longer length of stay, were receiving more medications, and had more comorbidity and fewer symptoms except for shortness of breath and altered mental state than those who were not receiving home care. Home care patients had four times as many myocardial infarctions and recurrent aspiration as the non-home care patients. Falls occurred five times more often, and urinary catheters were inserted twice as often. Except for oxygen saturation, time to achieve physiological stability was the same for the two groups of patients. Half (51.2%) of the home care patients passed the get-up-and-go test, compared with 75% (P<.001) of the non-home care patients.

Home care patients with CAP had an 11% mortality rate and a higher rate of complications than those who did not receive home care.