Chest
Original ResearchChest InfectionsPredictors of In-Hospital vs Postdischarge Mortality in Pneumonia
Section snippets
Sample Selection
Data analyzed in this study were part of the Medicare National Pneumonia Project, a component of CMS's Quality Improvement Program. As such, Human Subjects Committee approval is not required. Eligible patients were fee-for-service Medicare beneficiaries aged ≥ 65 years who had been discharged from the hospital during calendar years 2000 and 2001 with a principal diagnosis of pneumonia (International Classification of Disease, Ninth Edition, Clinical Modification codes 480.0-483.99, 485-486.99,
Results
There were 37,123 patients included in the initial sample. The most common reasons for exclusion were the lack of a working diagnosis of pneumonia at the time of admission (4,114), age younger than 65 years (3,478), lack of a confirmatory chest radiograph (3,241), prior hospital discharge within 14 days (1,548), and admission for comfort measures only (1,505). After all exclusions were applied, 21,223 cases were included in the analysis. Of the 2,561 patients (12.1%) who died within 30 days of
Discussion
Although risk factors for mortality in patients with pneumonia have been investigated extensively, there have been few studies comparing patient-specific factors for mortality before and after discharge from the hospital. In this analysis of patients on Medicare admitted to the hospital with pneumonia, we found that factors associated with the acute severity of pneumonia were predictive of in-hospital death but that the timing of death was unrelated to baseline patient demographic factors and
Acknowledgments
Author contributions: Dr Metersky is responsible for the integrity of the manuscript and is the guarantor.
Dr Metersky: contributed to study design, data analysis, and drafting the manuscript.
Dr Waterer: contributed to study design and drafting the manuscript.
Dr Nsa: contributed to study design, data analysis, critical review, and revision of the manuscript.
Dr Bratzler: contributed to obtaining funding, data analysis, critical review, and revision of the manuscript.
Financial/nonfinancial
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Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.
Funding/Support: The analyses upon which this publication is based were performed under funding by the Centers for Medicare & Medicaid Services, an agency of the US Department of Health and Human Services [Contract Number HHSM-500-2008-OK9THC].