Variation in the Diagnosis of Aspiration Pneumonia and Association with Hospital Pneumonia Outcomes.
Ann Am Thorac Soc. 2018 Jan 03;:
Authors: Lindenauer PK, Strait KM, Grady JN, Ngo CK, Parisi ML, Metersky M, Ross JS, Bernheim SM, Dorsey K
Rationale 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. Objectives To evaluate the rationale and impact of including aspiration pneumonia patients in hospital mortality and readmission measures. Methods Using Medicare fee-for-service claims for patients > 65 years from July 2012 - June 2015, we characterized the proportion of hospitals' pneumonia patients diagnosed with aspiration pneumonia, calculated hospital-specific risk-standardized rates of 30-day mortality and readmission for pneumonia patients, analyzed the association between aspiration pneumonia coding frequency and these rates, and re-calculated these rates including aspiration pneumonia patients. Measurements and Main Results 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' pneumonia patients diagnosed with aspiration pneumonia was 13.6% (10th-90th percentile: 4.2%-26%) Hospitals with a higher proportion of aspiration pneumonia patients 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. Conclusions Expanding the pneumonia cohorts to include patients with a principal diagnosis of aspiration pneumonia can overcome bias related to variation in hospital coding.
PMID: 29298090 [PubMed - as supplied by publisher]