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In Reply: We agree with Dr Mylotte that the decision to hospitalize nursing home residents with suspected pneumonia may be influenced by various factors, including family and resident preferences. A qualitative study we conducted that included interviewing 14 residents and their family members showed that both groups generally prefer that pneumonia be treated in the nursing home when possible.¹ Interviews performed with nurses, medical directors, and administrators revealed broad support for the pathway but also emphasized the need for adequate resources for implementation.^2-3

Mylotte is concerned that a substantial number of participants may have had viral LRTI based on the presence of radiographic infiltrates in only one third of residents. We caution against overinterpretation of radiographic infiltrate findings in this setting. First, when 4 radiologists read 25 radiographs from residents in this study, the agreement on presence or absence of an infiltrate was just fair; the intraclass correlation coefficient was . . . [Full Text of this Article]

Mark Loeb, MD, MSc
loebm@mcmaster.ca
Department of Pathology and Molecular Medicine

Soo Chan Carusone, PhD
Clinical Epidemiology and Biostatistics
McMaster University
Hamilton, Ontario

Thomas Marrie, MD
Department of Medicine
University of Alberta
Edmonton

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RELATED LETTER

Reducing Hospitalizations in Nursing Home Patients With Pneumonia
Joseph M. Mylotte
JAMA. 2006;296(18):2206-2207.
EXTRACT | FULL TEXT  

RELATED ARTICLE

Effect of a Clinical Pathway to Reduce Hospitalizations in Nursing Home Residents With Pneumonia: A Randomized Controlled Trial
Mark Loeb, Soo Chan Carusone, Ron Goeree, Stephen D. Walter, Kevin Brazil, Paul Krueger, Andrew Simor, Lorraine Moss, and Thomas Marrie
JAMA. 2006;295(21):2503-2510.
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