09.06.2006 Health

Treating nursing-home residents' pneumonia in-house would save millions: study

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Nursing home residents who develop pneumonia can be treated safely and effectively on-site instead of being transported to hospital, say researchers, who suggest that in-house programs would save Canada's health-care system tens of millions of dollars each year.

In a study of 680 residents in 22 long-term care facilities in the Hamilton area, researchers found that providing treatment within nursing homes cut hospital admissions for pneumonia and other lower-respiratory tract infections by more than half.

In-house diagnosis and treatment had other benefits as well, said lead researcher Dr. Mark Loeb, an infectious disease expert at McMaster University.

Sending elderly, often-frail residents to hospital for pneumonia may exacerbate underlying health conditions and put them at risk for drug-resistant bacterial infections that are becoming more common on the wards of large medical centres, Loeb said Tuesday from Hamilton.

Diagnosing and treating the disease in-house is also less disruptive for residents, who would otherwise have to be transported by ambulance to a hospital. "They get frightened, disoriented, going into the emergency department in the middle of the night. So what we're saying is you don't have to do this."

Pneumonia and other lower respiratory tract infections are common among residents of nursing homes and are among the most frequent reasons for transferring residents to hospital, say the authors, whose study is published in Wednesday's issue of the Journal of the American Medical Association.

In the study, half of the 680 men and women, aged 65 and older, were given a specific program of in-house treatment, while the other half received "usual care" - a mixed bag of programs in which residents might get some treatment in the nursing home and some in hospital.

The in-house treatment involved taking chest X-rays with portable machines, rehydrating patients and giving them supplemental oxygen and oral antibiotics - all under the watchful eye of a specially trained nurse.

Thirty-four of 327 residents (10 per cent) in the in-house treatment group needed hospitalization compared with 76 of 353 residents (22 per cent) in the usual care group. The first group's average hospital stay was less than a day versus almost two days for those in the second.

Death rates were similar: 24 residents (eight per cent) given in-house treatment died compared with 32 of those who received usual care (nine per cent). Quality of life and functional measures also were relatively equal.

But Loeb said in-home treatment was far less expensive, saving about $1,000 in health-care costs per resident.

"The data have important implications for the delivery of health-care services for both long-term care facilities and acute-care hospitals," he said. "We estimate that implementation of the (in-house) clinical pathway could result in a savings of $84 million (across Canada) annually."

The researchers say dealing with pneumonia within long-term care facilities would also help ease patient loads in emergency departments and hospital units, particularly during influenza season.

"It also speaks to pandemic preparedness," noted Loeb. "During SARS or during a pandemic, if there are individuals who have this (disease) in nursing homes, should they be cared for in hospital? This is evidence that with the appropriate resources you can safely manage people with pneumonia on-site in the nursing home."

Krista Robinson-Holt, director of health planning and research for the Ontario Long Term Care Association, called the study results a "good news story."

"We have always felt that our nursing homes can deliver more advanced care while saving the system dollars," said Robinson-Holt, whose organization's members include more than two-thirds of Ontario's 600 nursing homes and other long-term care facilities.

"This study, I think, really speaks to that fact because it demonstrates that when homes are enabled to do things like care pathways, it creates shorter hospitalizations and less of them. And there was quite a cost savings."

Dr. Morris Barer of the Canadian Institutes of Health Research, which partly funded the study, said the findings "point to ways seniors can receive the best available health care with the least possible disruption at a stage in their lives when any disruption can be a significant source of stress."

"This study is a compelling example of how evidence gained through health research can save money and strengthen our health-care system," said Barer, scientific director of CIHR's Institute of Health Services and Policy Research.

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