Chest Infections |

Thirty Day Readmission by Pneumonia Type and Overall in Harlem FREE TO VIEW

Anita Akhtar, MD; Jehanzeb Khan, MD; Munib Aftab, MD; Gene Pesola, MD
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Columbia University at Harlem Hospital, New York, NY

Chest. 2015;148(4_MeetingAbstracts):125A. doi:10.1378/chest.2277678
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SESSION TITLE: Chest infections Posters II

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 28, 2015 at 01:30 PM - 02:30 PM

PURPOSE: In recent years, re-admission for pneumonia within 30 days has become a standard for measurement of success for pneumonia treatment. Pneumonia re-admission includes both community acquired (CAP) and health care associated pneumonia (HCAP). The purpose of this investigation was to evaluate pneumonia re-admissions by subtype and overall.

METHODS: Over 9 months, re-admissions for pneumonia were analyzed to determine the 30 day re-admission rate. Pneumonias were divided into (CAP) and (HCAP) based on first admission. Diagnosis of pneumonia was by chest imaging with infiltrate and the appropriate clinical picture. The t-test compared differences between groups. Logistic regression analysis evaluated for factors independently associated with pneumonia re-admission. Data is mean + S.D. NS = not significant.

RESULTS: Over time 250 patients were admitted for presumed pneumonia. Forty six subjects did not have pneumonia for a diagnostic accuracy of 77.4%. Three, 2 HCAP and 1 CAP, were re-admissions for pneumonia after hospitalization elsewhere and 15 deaths (10-CAP; 5-HCAP) occurred on initial admission and were excluded from analysis. The remaining 186 patients, 131 CAP and 55 HCAP, were included for analysis. Mean ages for CAP and HCAP were different at 57 + 16 and 67 + 20 years, respectively (p < 0.01). Eight of 131 (6.1%) CAP and 9/55 (16.4%) HCAP were re-admitted for the actual diagnosis of pneumonia within 30 days (p < 0.05, Chi Square). Combining pneumonia overall, the mean age was 60 + 18 years for the group with ages of 67 + 20 and 59 + 18 for those readmitted versus not readmitted, respectively (NS). There was a 7.96 (95% C.I.;2.0 to 32.1), 4.2 (0.99 to 17.9), 5.1 (0.9 to 29.1), and 3.5 (0.8 to 14.9)-fold greater odds of having HIV infection, CHF, malignancy, or previous CVA respectively, in those readmitted for pneumonia compared to those not admitted for pneumonia.

CONCLUSIONS: Pneumonia diagnosis were inaccurate 22% of the time. Actual re-admissions for pneumonia within 30 days were significantly higher with HCAP compared to CAP, albeit the re-admission proportions were low. Risk factors for overall pneumonia readmission included underlying diagnosis of HIV infection, CHF, underlying malignancy, or previous CVA even though the patients were re-admitted for the pneumonia.

CLINICAL IMPLICATIONS: Discharge diagnosis of pneumonia are often incorrect penalizing hospitals unnecessarily. HCAP and underlying disease diagnosis are common reasons for pneumonia re-admissions and should be a focus to reduce readmissions.

DISCLOSURE: The following authors have nothing to disclose: Anita Akhtar, Jehanzeb Khan, Munib Aftab, Gene Pesola

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