Suaya Jose A, Tilahun Ermias, Harrison Vannessa, McLaughlin John M, Chilson Erica, Vietri Jeffrey, Swerdlow David L, Gessner Bradford D, Isturiz Raul E
Vaccines Medical Development and Medical/Scientific Affairs, Pfizer Inc, 235 E 42nd St, New York, NY 10017. Email:
Am J Manag Care. 2021 Aug 1;27(8):e261-e268. doi: 10.37765/ajmc.2021.88727.
Pneumonia hospitalization studies using administrative claims rely on pneumonia coded in the first discharge diagnosis field over pneumonia in any coded field, and few have evaluated disposition following discharge. This study reports the total disease burden and discharge disposition among patients with pneumonia coded in any diagnosis field.
Retrospective database review.
Data from the 2014 National Inpatient Sample of the Healthcare Cost and Utilization Project, a population-weighted, 20% sample of all US community hospitalizations, were analyzed for all pneumonia hospitalizations in adults aged 18 to 64 years and 65 years or older. Number of hospitalizations, hospital stay length, direct medical costs, in-hospital mortality, patient discharge disposition, illness severity, and likelihood of dying were evaluated based on the diagnosis field of pneumonia as a discharge diagnosis (eg, first, second, third, or further).
In 2014, an estimated 2.4 million US adult hospitalizations were associated with pneumonia in any of the discharge diagnosis positions (33%-35% in first, 33%-36% in second, and 29%-34% in further positions). When estimates were based only on hospitalizations with pneumonia in the first diagnosis field, approximately 66% of hospitalizations, 78% of hospital days, 87% of in-hospital deaths, 76% and 73% of transfers to short-term hospitals and skilled nursing facilities, 68% of discharges with home health care services, and 82% of direct medical costs were excluded.
Pneumonia hospitalizations were associated with substantial health care resource utilization and in-hospital mortality. Relying only on pneumonia in the first hospital diagnosis field may potentially underestimate the burden associated with pneumonia hospitalizations.
利用行政索赔进行的肺炎住院研究依赖于首次出院诊断字段中编码的肺炎，而非任何编码字段中的肺炎，并且很少有研究评估出院后的处置情况。本研究报告了在任何诊断字段中编码为肺炎的患者的总体疾病负担和出院处置情况。
回顾性数据库审查。
对医疗成本和利用项目2014年全国住院患者样本（美国所有社区住院患者的20%人口加权样本）进行分析，该样本涵盖18至64岁以及65岁及以上的成年肺炎住院患者。根据肺炎作为出院诊断的诊断字段（例如，第一、第二、第三或更靠后的字段），评估住院次数、住院时长、直接医疗费用、院内死亡率、患者出院处置情况、疾病严重程度以及死亡可能性。
2014年，估计有240万美国成年住院患者在任何出院诊断位置都与肺炎相关（第一位置为33% - 35%，第二位置为33% - 36%，更靠后的位置为29% - 34%）。当仅基于首次诊断字段中有肺炎的住院患者进行估计时，约66%的住院患者、78%的住院天数、87%的院内死亡患者、76%和73%转至短期医院和专业护理机构的患者、68%接受家庭医疗服务出院的患者以及82%的直接医疗费用被排除在外。
肺炎住院与大量医疗资源利用和院内死亡率相关。仅依赖首次医院诊断字段中的肺炎可能会低估与肺炎住院相关的负担。
