Table 1 Criteria for evaluating, excluding, and enrolling residents in the Missouri LRI Project.

Residents eligible for evaluation met one or more of the following three criteria:

   1. Two or more new lower respiratory symptoms (e.g., cough, shortness of breath, cyanosis)

   2. One new respiratory symptom and at least one sign of an acute change in condition (e.g., fever, decreased alertness, new or increased confusion)

   3. At least one sign of an acute change in condition and no evidence of stroke, gastroenteritis, urine infection, constipation/fecal impaction, or an adverse drug reaction

Residents were excluded from evaluation if they met one or more of the following criteria:

   1. Did not meet evaluation criteria (above)

   2. Resident or a family member declined evaluation, or resident's physician excluded them from the protocol

   3. Resident's physician was not signed on to the protocol

   4. Resident was not well and off antibiotics for at least seven days following a prior LRI

   5. Resident was not at least 60 years of age

   6. Resident had less than one month life expectancy, resident was a hospice patient, or resident had AIDS

   7. Resident had a "no antibiotics" order in effect

   8. Illness episode was missed

   9. Resident had not been in facility for at least 14 days

The six enrollment criteria were

   1. New or increased cough

   2. New or increased sputum production

   3. Fever

   4. Pleuritic chest pain

   5. New or increased physical findings on chest examination (rales, rhonchi, wheezes, or bronchial breathing)

   6. One or more indications of change in status or breathing difficulty (new or increased shortness of breath, respiratory rate > 25, and worsening mental or functional status)

Residents were enrolled if, after evaluation, they met three or more of the above enrollment criteria, or they met two criteria and had chest x-ray findings positive for pneumonia. We further required that residents with congestive heart failure or chronic obstructive pulmonary disease had either a fever or a chest x-ray that was positive for pneumonia to avoid confusing an acute exacerbation of their condition with an LRI.