Describing patterns of functional status across the episode of illness in community-acquired pneumonia patients
Creators: name: Larsen, Lorrie Dawson
Publisher: name: University of Utah
Year: 2012
Subjects: Health Decisions
Clinical Management

description: Community-acquired pneumonia (CAP) is a significant problem in adults and is associated with substantial morbidity and mortality.  Because of the high volume of patients treated for CAP, the costs are substantial.  The decision of whether or not to hospitalize in an important clinical management decision.   Assessment of functional status, availability of social support, and symptom severity plays an important role in this decision.  In order to make this decision in the patients' behalf, health care providers need information about the effect of CAP on functional status and the subsequent need for caregiver support and to understand the patients' views of their illness and its symptoms.   The purpose of this study was to describe the change pattern in functional status across the episode of illness in CAP patients and to compare the results of patient interviews to responses on two functional status assessment questionnaires: (a) the SF-36[TM] Health Survey and (b) the Pulmonary Functional Status and Dyspnea Questionnaire (PFSDQ). The sample of 44 patients was obtained by convenience sampling from six semiacute facilities (Instacares) in the metropolitan Salt Lake City area.  Three individuals were dropped from the study and 5 others had missing data at one or more of the seven interview periods. Qualitative data were analyzed using content analysis, whereas quantitative data were analyzed using individual regression, t tests, one-way analysis of variance (ANOVA), Fisher's exact test, and Pearson's r. Qualitative and quantitative data were conceptually compared for linkage. Results included the findings that there are at least five patterns of symptom and functional status recovery in CAP patients:  (a) those who score high at baseline and remain high until Day 2; (b) persons who score high at baseline and drop rapidly in score; (c) those who score low at baseline and continue to score low over the episode of illness; (d) individuals who peak (or increase) in score after baseline; and (e) the most frequent pattern, those who have moderate symptom severity and functional status impairment scores on the standardized instruments at baseline with a gradual decrease in score over time.  Findings also included that persons in the sample without caregivers to provide tangible aid in performing home management task were 14 times more likely to relapse than persons with this form social support.  In addition, significant functional status impairment and serve symptoms were reported by persons with CAP in the semisstructured interview.  The majority of the findings in this study were measured by the SF-36[TM] Health Survey, the PFSDQ, and/or the Community-Acquired Pneumonia Symptom Severity Checklist (CAPSSC).  However, the two most frequently listed functional status impairments ("inability to work" and "inability to adequately care for children") were not covered by any of the standardized measures.  Triangulation of the results of the semistructured interview with standardized measures also showed support for the conceptual model developed for the study by combining the "Dyspnea Spiral" and "Common Sense Model" to explain schema held by CAP patients regarding their illness.  Information gained from this study can be used by clinicians to determine appropriate functional status, social support, and symptom severity assessment strategies in adults with CAP.