1 Institute for Healthcare Delivery and Population Science, and.
2 Department of Medicine, University of Massachusetts Medical School-Baystate, Springfield, Massachusetts.
Ann Am Thorac Soc. 2018 May;15(5):562-569. doi: 10.1513/AnnalsATS.201709-728OC.
National efforts to compare hospital outcomes for patients with pneumonia may be biased by hospital differences in diagnosis and coding of aspiration pneumonia, a condition that has traditionally been excluded from pneumonia outcome measures.
To evaluate the rationale and impact of including patients with aspiration pneumonia in hospital mortality and readmission measures.
Using Medicare fee-for-service claims for patients 65 years and older from July 2012 to June 2015, we characterized the proportion of hospitals' patients with pneumonia diagnosed with aspiration pneumonia, calculated hospital-specific risk-standardized rates of 30-day mortality and readmission for patients with pneumonia, analyzed the association between aspiration pneumonia coding frequency and these rates, and recalculated these rates including patients with aspiration pneumonia.
A total of 1,101,892 patients from 4,263 hospitals were included in the mortality measure analysis, including 192,814 with aspiration pneumonia. The median proportion of hospitals' patients with pneumonia diagnosed with aspiration pneumonia was 13.6% (10th-90th percentile, 4.2-26%). Hospitals with a higher proportion of patients with aspiration pneumonia had lower risk-standardized mortality rates in the traditional pneumonia measure (12.0% in the lowest coding and 11.0% in the highest coding quintiles) and were far more likely to be categorized as performing better than the national mortality rate; expanding the measure to include patients with aspiration pneumonia attenuated the association between aspiration pneumonia coding rate and hospital mortality. These findings were less pronounced for hospital readmission rates.
Expanding the pneumonia cohorts to include patients with a principal diagnosis of aspiration pneumonia can overcome bias related to variation in hospital coding.
全国范围内比较肺炎患者的医院治疗效果可能存在偏差，因为各医院对吸入性肺炎（一种传统上不包含在肺炎治疗效果评估中的疾病）的诊断和编码存在差异。
评估将吸入性肺炎患者纳入医院死亡率和再入院率评估中的原理和影响。
我们使用了 2012 年 7 月至 2015 年 6 月 Medicare 按服务收费制的患者数据，分析了诊断为肺炎的患者中患有吸入性肺炎的比例，计算了肺炎患者 30 天死亡率和再入院率的医院特异性风险标准化率，分析了吸入性肺炎编码频率与这些比率的相关性，并计算了包含吸入性肺炎患者的这些比率。
共有来自 4263 家医院的 1101892 名患者纳入死亡率评估分析，其中 192814 名患者患有吸入性肺炎。诊断为肺炎的患者中患有吸入性肺炎的医院比例中位数为 13.6%（第 10 百分位数至第 90 百分位数，4.2%至 26%）。编码率较高的医院，其传统肺炎评估中的风险标准化死亡率较低（编码最低的为 12.0%，编码最高的为 11.0%），且更有可能被归类为比全国死亡率表现更好；将评估标准扩展到包括患有吸入性肺炎的患者，可以减轻与医院死亡率相关的吸入性肺炎编码率的偏倚。但对于医院再入院率，这种关联则不太明显。
将肺炎患者队列扩展到包括以吸入性肺炎为主要诊断的患者，可以克服与医院编码差异相关的偏倚。
