A Clinical Pathway for Nursing Home Acquired Pneumonia

Pneumonia Clinical Trial

Official title:

A Randomized Control Trial of a Clinical Pathway for Nursing Home Pneumonia.

Clinical Trial Details — Status: Completed

Administrative data

• NCT number: NCT00157612
• Other study ID #: 00-1848
• Secondary ID: long term care
• Status: Completed
• Phase: N/A
• Start date: January 2001
• Est. completion date: July 2005

Study information

• Verified date: October 2018
• Source: McMaster University
• Contact: n/a
• Is FDA regulated: No
• Study type: Interventional

Clinical Trial Summary

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.

Description:

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.

Recruitment information / eligibility

• Status: Completed
• Enrollment: 680
• Est. completion date: July 2005
• Est. primary completion date: July 2005
• Accepts healthy volunteers: No
• Gender: All
• Age group: 64 Years and older

Eligibility

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.

Related Conditions & MeSH terms

• Lower Respiratory Tract Infection
• Pneumonia
• Respiratory Tract Infections

Intervention

Procedure:
• a clinical pathway nursing home acquired pneumonia
treatment in nursing homes according to a clinical pathway, which included use of oral anti-microbials, portable chest radiographs, oxygen saturation monitoring, rehydrations and close monitoring by research nurse

Locations

Country	Name	City	State
n/a

Sponsors (2)

Lead Sponsor	Collaborator
McMaster University	Canadian Institutes of Health Research (CIHR)

References & Publications (1)

Loeb M, Carusone SC, Goeree R, Walter SD, Brazil K, Krueger P, Simor A, Moss L, Marrie T. Effect of a clinical pathway to reduce hospitalizations in nursing home residents with pneumonia: a randomized controlled trial. JAMA. 2006 Jun 7;295(21):2503-10. — View Citation

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	Hospital admission, length of stay
Secondary	Health related quality of life,
Secondary	complication rates,
Secondary	mortality,
Secondary	functional status,
Secondary	time to stabilization of vital signs