EVELYN HUTT, MD ANDREW M. KRAMER, MD Denver, Colorado From the Center on Aging Research Section, University of Colorado Health Sciences Center, Denver, CO. This work was funded by Merck & Co., Inc. through the Quality Care Research Fund and the Academic Medicine and Managed Care Forum sponsored by Aetna. The contract number is Merck PN9910 046. Address reprint requests to Evelyn Hutt, MD, Assistant Professor, Center on Aging Research Section, University of Colorado Health Sciences Center, Campus Box B179, 3570 East 12th Avenue, Suite 300, Denver, CO 80206. E-mail: Evelyn.Hutt@uchsc.edu
The guidelines have 2 important limitations. They have not yet been approved by any official professional society, nor have they been tested prospectively. Prospective testing is required to validate whether, in fact, the proposed guidelines can be implemented and, if implemented, they will improve mortality, function, cost of care, rehospitalization rates, and community discharge rates. We chose not to seek official approval of the guidelines until they can be proven effective.
We believe the proposed guidelines can and should be used to the fullest extent possible by nursing homes and physicians who practice there, because the combination of evidence and consensus is strong. Nursing home-acquired pneumonia causes excess mortality and functional loss. The proposed guidelines, based as they are in empiric evidence, common sense, and expert consensus, offer some hope of decreasing rehospitalization and cost, mitigating functional decline, and improving survival.
APPENDIX: PANEL MEMBERS . Diana Blake, RN, Western Hills Health Care Center, Lakewood, CO; JoAnn G. Congdon, RN, PhD, University of Colorado HSC, Denver, CO; Douglas Fish, PharmD, University of Colorado, Denver, CO; Evelyn Hutt, MD, University of Colorado HSC, Denver, CO; Denise Iskra, RN, Life Care of Westminster, Westminster, CO; Andrew M. Kramer, MD, University of Colorado, Denver, CO; Thomas J. Marrie, MD, University of Alberta, Edmonton, Alberta, Canada; Mark Loeb, MD, McMaster University, Hamilton, Ontario, Canada; Wayne C. McCormick, MD, MPH, Harborview Medical Center, Seattle, WA; Annette M. Medina-Walpole, MD, University of Rochester, Rochester, NY; David R. Mehr, MD, MS, University of Missouri–Columbia, Columbia, MO; Michael S. Niederman, MD, State University of New York at Stony Brook, Mineola, NY; Phillip K. Peterson, MD, University of Minnesota, Minneapolis, MN; J. Mark Ruscin, PharmD, University of Colorado, Denver, CO; Thomas T. Yoshikawa, MD, Charles Drew University, Los Angeles, CA.
Acknowledgments
The authors acknowledge the members of the panel for their thoughtful participation and willingness to review multiple drafts of the guidelines and manuscript; Steven Teutsch, MD, Senior Director, Outcomes Research and Management, Merck & Co., Inc., for his support and advice; Lisa Lampinen for manuscript preparation; and Merck & Co., Inc., for funding.
