L K Hoe1, L T Keang. 1. Department of Medicine, National University Hospital, Singapore.
Abstract
OBJECTIVE: In the USA, a group of low-risk patients with community-acquired pneumonia (CAP) with a low risk of mortality were identified and it was suggested that they may be treated as outpatients to save costs. We evaluated the outcome of these low-risk CAP patients that were hospitalized in our local setting, and gauged the number of such patients in order to estimate the potential cost-savings by treating them as out-patients, as well as the safety of such an approach. METHODOLOGY: All patients with CAP admitted to the National University Hospital, Singapore, from 1 April to 1 November 1997 were enrolled into a prospective cohort study. Low-risk patients were identified, and their hospital outcomes were compared with the other patients. Hospitalization charges were obtained from the Finance Department. RESULTS: There were 155 CAP patients (69 females and 86 males). The age was 56.6 +/- 22.2 years, ranging from 12 to 93 years old. The average hospital stay was 8.4 +/- 11 days. Mortality was 12.9%. There were 37 (24%) low-risk CAP patients, and there was no mortality in this group. No low-risk patient required mechanical ventilation. They had a significantly shorter hospital stay compared with high-risk patients. An identifiable organism was found in 27% of the low-risk CAP with only one patient having a positive blood culture. The average hospitalization charge for low-risk CAP patients was, as expected, significantly lower than for the high-risk patients, and was 11.9% of the total cost for hospitalized CAP patients. CONCLUSION: Nearly one-quarter of our CAP admissions consisted of low-risk patients that had no mortality, and required a significantly shorter hospitalization period. The management of such patients who are young (< or = 50 years), and had no serious coexisting conditions in an out-patient setting, may lead to significant cost-savings as the average hospitalization charge was US$1295 and 11.9% of total hospitalization charges for CAP.
OBJECTIVE: In the USA, a group of low-risk patients with community-acquired pneumonia (CAP) with a low risk of mortality were identified and it was suggested that they may be treated as outpatients to save costs. We evaluated the outcome of these low-risk CAPpatients that were hospitalized in our local setting, and gauged the number of such patients in order to estimate the potential cost-savings by treating them as out-patients, as well as the safety of such an approach. METHODOLOGY: All patients with CAP admitted to the National University Hospital, Singapore, from 1 April to 1 November 1997 were enrolled into a prospective cohort study. Low-risk patients were identified, and their hospital outcomes were compared with the other patients. Hospitalization charges were obtained from the Finance Department. RESULTS: There were 155 CAPpatients (69 females and 86 males). The age was 56.6 +/- 22.2 years, ranging from 12 to 93 years old. The average hospital stay was 8.4 +/- 11 days. Mortality was 12.9%. There were 37 (24%) low-risk CAPpatients, and there was no mortality in this group. No low-risk patient required mechanical ventilation. They had a significantly shorter hospital stay compared with high-risk patients. An identifiable organism was found in 27% of the low-risk CAP with only one patient having a positive blood culture. The average hospitalization charge for low-risk CAPpatients was, as expected, significantly lower than for the high-risk patients, and was 11.9% of the total cost for hospitalized CAPpatients. CONCLUSION: Nearly one-quarter of our CAP admissions consisted of low-risk patients that had no mortality, and required a significantly shorter hospitalization period. The management of such patients who are young (< or = 50 years), and had no serious coexisting conditions in an out-patient setting, may lead to significant cost-savings as the average hospitalization charge was US$1295 and 11.9% of total hospitalization charges for CAP.