Meehan TP, Fine MJ, Krumholz HM, Scinto J, Galusha D, Houck P, Petrillo MK, Mockalis J, Weber G, Fine JM; Association for Health Services Research. Meeting.
Abstr Book Assoc Health Serv Res Meet. 1997; 14: 294-5.
Connecticut Peer Review Organization, Middletown, CT 06457, USA.
OBJECTIVES: To assess quality of care for elderly patients (3 65 years) hospitalized with pneumonia by measuring performance of four processes of care, and to determine whether performance of each process of care is associated with lower 30-day mortality. DESIGN: Multicenter retrospective cohort study. SETTING: 3,551 acute care hospitals throughout the United States and Puerto Rico. PATIENTS: 14,136 hospitalizations for pneumonia among Medicare patients between October 1, 1994 and September 30, 1995. MAIN OUTCOME MEASURES: Medical records were reviewed to determine performance of four processes of care identified as important by literature review and expert panel consensus: 1) oxygenation assessment within 24 hours of hospital arrival, 2) blood culture collection within 24 hours of hospital arrival, 3) blood culture collection before initial hospital antibiotics, and 4) timing of initial antibiotic administration. Process of care performance rates were assessed on a state-by-state level for all 14,136 pneumonia discharges, and on a national level for 1,347 discharges randomly selected from each state in proportion to Medicare discharges in each state. Associations between processes of care and 30-day mortality were assessed in all 14,136 pneumonia discharges. Odds ratios (OR) and 95% confidence intervals (CI) were calculated for each process measure. Logistic regression analysis was used to adjust for illness severity using a validated pneumonia-specific index. RESULTS: National process of care performance rates and (state-by-state performance ranges) are as follows: 1) oxygenation assessment within 24 hours of hospital arrival 89.3% (70.7-97.3%), 2) blood culture collection within 24 hours of hospital arrival 68.6% (45.6-82.2%), 3) blood culture collection before initial hospital antibiotics 57.3% (32.4-73.6%), and 4) initial antibiotic administration within 8 hours of hospital arrival 75.6% (47.0-89.6%). Antibiotic administration within 8 hours of hospital arrival (OR 0.84, 95% CI 0.74 to 0.95) and blood culture collection within 24 hours of arrival (OR 0.89, 95% CI 0.80 to 0.99) were associated with lower 30-day mortality, after adjusting for severity of illness at hospital presentation. CONCLUSION: Opportunities exist to improve processes of hospital care for elderly patients with pneumonia and these opportunities are not uniformly distributed throughout the United States. Collection of blood cultures within 24 hours of hospital arrival and timely administration of antibiotics are associated with improved survival. RELEVANCE TO CLINICAL PRACTICE AND POLICY: Pneumonia is a common reason for hospitalization among Medicare patients. The Health Care Financing Administration has initiated a national quality improvement effort to improve hospital-based pneumonia care by assessing performance of selected processes of care and linking performance to improved survival. Hospitals and clinicians will be approached by representatives of local peer review organizations to use these data to improve care.
Publication Types:
Keywords:
- Aged
- Anti-Bacterial Agents
- Centers for Medicare and Medicaid Services (U.S.)
- Confidence Intervals
- Hospitalization
- Hospitals
- Humans
- Medicare
- Outcome Assessment (Health Care)
- Outcome and Process Assessment (Health Care)
- Pneumonia
- Process Assessment (Health Care)
- Professional Review Organizations
- Puerto Rico
- United States
- economics
- hsrmtgs
Other ID:
UI: 102233837
From Meeting Abstracts