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

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.

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Affiliations

Authors

Corresponding author

Correspondence to Joshua P. Metlay MD, PhD.

Additional information

This research was part of the Pneumonia Patient Outcomes Research Team (PORT) Project funded by the Agency for Health Care Policy and Research (grant R01 HS06468). Dr. Metlay is supported by a General Medicine Research Fellowship, NRSA grant 5T32PE11001-08. Dr. Fine is supported as a Robert Wood Johnson Foundation Generalist Physician Faculty Scholar.

Address correspondence and reprint requests to Dr. Metlay: General Internal Medicine Unit, 50 Staniford St., 9th Floor, Massachusetts General Hospital, Boston, MA 02114. *** DIRECT SUPPORT *** A02BX003 00005

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Metlay, J.P., Fine, M.J., Schulz, R. et al. Measuring symptomatic and functional recovery in patients with community-acquired pneumonia. J GEN INTERN MED 12, 423–430 (1997). https://doi.org/10.1046/j.1525-1497.1997.00074.x

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Key words

  • pneumonia
  • health status
  • outcomes assessment
  • questionnaires