Original Articles

Journal of General Internal Medicine

, Volume 12, Issue 7, pp 423-430

Measuring symptomatic and functional recovery in patients with community-acquired pneumonia

  • Joshua P. MetlayAffiliated withGeneral Internal Medicine Unit, Department of Medicine, Massachusetts General Hospital and Harvard Medical School
  • , Michael J. FineAffiliated withDivision of General Internal Medicine, Department of Medicine and Center for Research on Health Care, University of Pittsburgh
  • , Richard SchulzAffiliated withDepartment of Psychiatry, University of Pittsburgh
  • , Thomas J. MarrieAffiliated withDepartment of Medicine and Microbiology, Victoria General Hospital and Dalhousie University
  • , Christopher M. ColeyAffiliated withGeneral Internal Medicine Unit, Department of Medicine, Massachusetts General Hospital and Harvard Medical School
  • , Wishwa N. KapoorAffiliated withDivision of General Internal Medicine, Department of Medicine and Center for Research on Health Care, University of Pittsburgh
  • , Daniel E. SingerAffiliated withGeneral Internal Medicine Unit, Department of Medicine, Massachusetts General Hospital and Harvard Medical School

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Abstract

Objective

To determine the rates of resolution of symptoms and return to premorbid health status and assess the association of these outcomes with health care utilization in patients with community-acquired pneumonia.

Design

A prospective, multicenter cohort study.

Setting

Inpatient and outpatient facilities at three university hospitals, one community hospital, and one staff-model health maintenance organization.

Patients

Five hundred seventy-six adults (aged≥18 years) with clinical and radiographic evidence of pneumonia, judged by a validated pneumonia severity index to be at low risk of dying.

Measurements and main results

The presence and severity of five symptoms (cough, fatigue, dyspnea, sputum, and chest pain) were recorded through questionnaires administered at four time points: 0, 7, 30, and 90 days from the time of radiographic diagnosis of pneumonia. A summary symptom score was tabulated as the sum of the five individual severity scores. Patients also provided responses to the Medical Outcomes Study 36-Item Short Form Health Survey (SF-36) and reported the number of and reason for outpatient physician visits. Symptoms and health status 30 days before pneumonia onset (prepneumonia) were obtained at the initial interview. All symptoms, except pleuritic chest pain, were still commonly reported at 30 days, and the prevalence of each symptom at 90 days was still nearly twice prepneumonia levels. Physical health measures derived from the SF-36 Form declined significantly at presentation but continued to improve over all three follow-up time periods. Patients with elevated symptom scores at day 7 or day 30 were significantly more likely to report pneumonia-related ambulatory care visits at the subsequent day 30 or day 90 interviews, respectively.

Conclusions

Disease-specific symptom resolution and recovery of the premorbid physical health status requires more than 30 days for many patients with pneumonia. Delayed resolution of symptoms is associated with increased utilization of outpatient physician visits.

Key words

pneumonia health status outcomes assessment questionnaires