SESSION TYPE: Pneumonia Morbidity and Mortality
PRESENTED ON: Sunday, October 21, 2012 at 01:15 PM - 02:45 PM
PURPOSE: Pneumonia is a diagnosis which frequently prompts hospitalization. We aimed to evaluate trends in mortality and resource utilization for patients requiring hospitalization for pneumonia.
METHODS: We performed a retrospective temporal trends study using data from the Nationwide Inpatient Sample (NIS) - a large, all-payer, inpatient care database with data from nearly 8 million hospital stays per year across 44 states in the U.S. Records of adult patients hospitalized with the principal diagnosis of pneumonia from 2005 to 2009 were included.
RESULTS: During this time period, there were 5.3 million discharges for the primary diagnosis of pneumonia. In-hospital mortality decreased from 4.59%+/-0.08 in 2005 to 4.01%+/-0.07 in 2009 (p=0). LOS decreased from 5.86+/-0.05 days in 2005 to 5.60+/-0.05 days (p=.0002) in 2009. After inflation-adjustment, cost per case did not change. Between 2005 and 2009, the proportion of patients with extreme severity of illness (SOI) by APR-DRG (7.21%+/-0.14 versus 12.16%+/-0.22, p=0), bronchoscopy rates (4.88%+/-0.18 versus 5.56%+/-0.21, p=.031), intubation/mechanical ventilation rates (4.52%+/-0.11 versus 6.43%+/-0.15, p=0), thoracentesis/pleural procedures/chest drainage rates (2.65%+/-0.06 versus 3.17%+/-0.07) and number of diagnoses (8.04+/-0.06 versus 10.40+/-0.09, p=0) increased.
CONCLUSIONS: Quality of care, measured by in-hospital mortality, for patients hospitalized with the principal diagnosis of pneumonia improved from 2005 to 2009. This occurred while medical complexity and the proportion of patients with extreme SOI increased. During this same time period, LOS decreased, invasive procedure rates increased, and costs did not change. Potential explanations for these findings include increased adherence to quality of care process measures, implementation of guideline recommendations regarding suitability for discharge, or more aggressive medical care utilizing invasive procedures. Improvements in LOS may have offset costs created by invasive procedures. Documentation practices may account for changes in SOI scores and number of diagnoses.
CLINICAL IMPLICATIONS: Although the observational design limits inferences about specific causative factors for these trends, adherence to quality measures and implementation of guideline recommendations should continue to be supported by hospitals as a method of improving quality of care and containing costs.
DISCLOSURE: The following authors have nothing to disclose: Chapy Venkatesan, Alita Mishra, Maria Stepanova, Natanyah Siegel, Zobair Younossi
No Product/Research Disclosure InformationInova Fairfax Hospital, Falls Church, VA