Patients hospitalized with community-acquired pneumonia:: a comparative study of outcomes by medical specialty area

OBJECTIVE: Variability in the management of patients hospitalized with community-acquired pneumonia (CAP) is attributable to many factors. The objective of this study was to determine whether such variability is influenced by the medical specialty area where the patient is treated. PATIENTS AND METHODS: The treatment and outcomes for a random sample of patients with CAP admitted to 4 hospitals over 2 periods (I year starting March 1, 1998, and 1.5 years starting March 1, 2000) were compared by medical specialty department. Multiple linear and logistic regression models were used to analyze differences. RESULTS: Differences were found between departments in the coverage of atypical pathogens (P <.001). The adjusted mean length of stay in hospital varied between 6.8 and 9.1 days (P <.01), and the duration of intravenous treatment varied between 4.6 and 7.3 days (P <.05). Adjusted models showed that mortality in hospital and at 30 days was significantly higher for patients treated in internal medicine departments (odds ratios, 2.1 and 2, respectively) than for those treated in pulmonology departments. CONCLUSIONS: Interdepartmental differences were observed in how patients hospitalized with CAP were treated and in the outcomes achieved. This variation is probably influenced by the differences that were found in the use of antibiotics.