Nursing home residents are frequently transferred to hospital for management of pneumonia. This often leads to hospital related complications and is a burden on the acute care health system. The purpose of this study is to assess whether managing residents with pneumonia and lower respiratory tract infection on site in the nursing home can reduce hospital admissions and can reduce complications and improve quality of life for residents. We have randomized residents with nursing home acquired pneumonia to on-site management, using a clinical pathway, versus usual care.

Condition	Intervention
Pneumonia Lower Respiratory Tract Infection	Procedure: a clinical pathway for the management of nursing home acquired pneumonia

Further Study Details: 

Primary Outcomes: Hospital admission, length of stay
Secondary Outcomes: Health related quality of life,; complication rates,; mortality,; functional status,; time to stabilization of vital signs
Expected Total Enrollment:  680

We conducted a cluster-randomized controlled trial where nursing homes were randomized to either use of a clinical pathway or usual care for management of nursing home acquired pneumonia. The clinical pathway included chest radiographs performed on-site in the nursing home by a mobile x-ray unit, use of hypodermocylysis (subcutaneous infusion) for re-hydration, administration of an oral antimicrobials, and use of pulse oximetry to assess oxygenation. The main outcomes were hospital admission rate and length of stay. Secondary outcomes included health related quality of life, rates of both infectious and non-infectious complications within four weeks of onset of symptoms; mortality rate of residents with pneumonia (death from all causes within 30 days of onset of symptoms. Time to stabilization of vital signs, as well as functional status at four weeks, were assessed.

Ages Eligible for Study:  64 Years and above,  Genders Eligible for Study:  Both

Criteria

Inclusion Criteria:

• Symptoms or signs of lower respiratory tract infection as defined by standardized criteria.

Exclusion Criteria:

• Residents were excluded if they were not expected to live longer than 30 days from the date of enrollment, had a previous anaphylactic or serious allergic reaction to quinolones, had advanced directives that they are not be transferred to hospital for treatment.

Study chairs or principal investigators

Mark B Loeb, MD MSc FRCPC,  Principal Investigator,  McMaster University   

Study ID Numbers:  00-1848; CRT-43826
Last Updated:  September 10, 2005
Record first received:  September 7, 2005
ClinicalTrials.gov Identifier:  NCT00157612
Health Authority: Canada: Health Canada
ClinicalTrials.gov processed this record on 2005-09-13