Reducing Readmissions in Community-Acquired Pneumonia

Reducing Readmissions in Community-Acquired Pneumonia

In the United States, community-acquired pneumonia (CAP) is the leading cause of morbidity and mortality due to infection and most often strikes the elderly and individuals with comorbidities. The 30-day mortality rate for Medicare patients admitted to the hospital for CAP is about 12% and has not changed significantly in decades (Table 1). CAP has been shown to increase long-term mortality to as high as 40% within 1 year of admission. The infection is one of seven conditions that account for nearly 30% of potentially preventable readmissions in the 15-day window after initial hospital discharge. Estimates show that the cost of treating CAP exceeds $17 billion per year. Hospitalizing Patients With Community-Acquired Pneumonia “The decision on whether or not hospitalization is necessary for CAP is critical because there are multiple consequences,” says Thomas M. File, Jr., MD, MSc. “Hospitalizations can influence the cost of care, the intensity of diagnostic testing, and the selection of antimicrobial agents.” There are several advantages to outpatient treatment of CAP—when used appropriately—including cost, patient preference, faster convalescence, and fewer nosocomial complications. Hospitalization decisions should be based on several factors, including (among others): age over 50; significant underlying coexisting conditions; elevated blood urea nitrogen levels; and the presence of altered mental status or significant abnormalities in vital signs. “Readmission for CAP patients recently discharged after hospitalization represents an important, expensive, and often preventable adverse outcome,” Dr. File says. “The risk of readmission can be modified by the quality and type of care that is provided. Improving CAP readmission rates is the joint responsibility of hospitals and clinicians.” He adds that measuring readmission rates can help...

Welcome Guidelines for Managing Rhinosinusitis

Recent estimates suggest that the direct annual costs of sinusitis are approximately $5.8 billion in the United States, and nearly one in seven Americans is diagnosed with a sinus infection every year. Rhinosinusitis is one of the most common reasons patients seek medical help. It ranks among the top five reasons for antibiotic prescriptions for adults. However, 90% to 98% of patients presenting with symptoms of sinusitis have viral causes and will not benefit from antibiotics. The overuse of antibiotics among this population has contributed largely to the emergence of antimicrobial resistance. The Need for Guidance “Clinicians need clear guidance on how to treat patients with rhinosinusitis and on how to differentiate viral from bacterial infections,” says Thomas M. File, Jr., MD. In the April 15, 2012 issue of Clinical Infectious Diseases, Dr. File coauthored guidelines from the Infectious Disease Society of America (IDSA) on acute bacterial rhinosinusitis in children and adults. “Reasonable criteria are needed for making decisions on when it’s appropriate to prescribe antibiotics in rhinosinusitis,” he says. “We also wanted to provide an update on the information available on the bacteria that are causing bacterial sinusitis as a result of emerging resistance [Table 1].” With no simple test to quickly determine whether an infection is viral or bacterial, many physicians prescribe antibiotics to play it safe. According to Dr. File, this practice has led patients to expect to receive antibiotics when they have an infection. “If they aren’t prescribed one, they may be dissatisfied with the patient–physician interaction,” he adds. “Patients and physicians both need to be educated that using antibiotics when they’re unwarranted will provide...