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Quality Care for Pneumonia in the Elderly

Quality Care for Pneumonia in the Elderly
Author Information (click to view)

Jonathan S. Lee, MD

Chief Medical Resident
Division of General Internal Medicine
Department of Medicine
University of Pittsburgh School of Medicine

Jonathan S. Lee, MD, has indicated to Physician’s Weekly that he has no financial interests to disclose.

Figure 1 (click to view)
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Jonathan S. Lee, MD (click to view)

Jonathan S. Lee, MD

Chief Medical Resident
Division of General Internal Medicine
Department of Medicine
University of Pittsburgh School of Medicine

Jonathan S. Lee, MD, has indicated to Physician’s Weekly that he has no financial interests to disclose.

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Adherence to recommended processes of care for patients hospitalized with pneumonia is publicly reported throughout the United States by CMS. Despite this reporting, little is known regarding whether more physicians are now performing these process measures and how they have impacted patient outcomes.

Taking a Closer Look

For a study published in JAMA Internal Medicine, Jonathan S. Lee, MD, and colleagues sought to describe the processes of care, mortality, and readmissions for elderly patients hospitalized with pneumonia. “The morbidity and mortality associated with pneumonia are especially prominent in the elderly,” says Dr. Lee. “We assessed how these patients are being cared for and whether there are steps that should be taken to potentially improve their mortality and readmissions rates.”

The researchers conducted a retrospective analysis that involved more than 1.8 million Medicare fee-for-service patients aged 65 and older who were hospitalized for pneumonia in 2006 to 2010. Participants were eligible for at least one of seven inpatient processes of care that are tracked by CMS during their hospitalization, including:

  • Influenza vaccination.
  • Pneumococcal vaccination.
  • Smoking cessation counseling.
  • Performance of blood cultures before antibiotic therapy in the ED.
  • Performance of blood cultures within 24 hours for ICU patients.
  • Appropriate antibiotic selection.
  • Antibiotic initiation within 6 hours.

Based on the processes and outcomes of care, Dr. Lee and colleagues assessed the quality of care for pneumonia from 2006 to 2010. “By 2010, more than 92% of patients were receiving all of the processes of care for which they were eligible,” Dr. Lee says. “Mortality and readmission rates both decreased slightly during the study period. All seven processes of care were associated with reduced mortality, but we can’t say whether our observed relationships were causal.”

Overall, five processes were associated with reduced 30-day readmission. The annual mortality rate decreased by 0.09% per year and was driven mostly by decreasing mortality among those treated on hospital wards rather than in the ICU. Readmission rates also decreased by 0.25% per year during the study period.

Important Implications

“It’s important for clinicians to understand that—while antibiotics and supportive care are the backbone of treating pneumonia—there are steps we can take to help improve our patients’ outcomes, even within those areas,” says Dr. Lee. “Guideline-appropriate antibiotics should be given quickly following a pneumonia diagnosis. Preventive interventions are also important and include pneumococcal and influenza vaccination and smoking cessation counseling. Clinicians should be aware of these processes of care because they’re being measured on them, but also because they may in fact help reduce mortality and readmission risk.”

Readings & Resources (click to view)

Lee J, Nsa W, Hausmann L, et al. Quality of care for elderly patients hospitalized for pneumonia in the United States, 2006 to 2010. JAMA Intern Med. 2014;174:1806-1814. Available at http://archinte.jamanetwork.com/article.aspx?articleid=1901118.

Mandell L, Wunderink R, Anzueto A, et al. Infectious Diseases Society of America; American Thoracic Society. Infectious Diseases Society of America/American Thoracic Society consensus guidelines on the management of community-acquired pneumonia in adults. Clin Infect Dis. 2007;44:S27-S72.

Bratzler D, Nsa W, Houck P. Performance measures for pneumonia: are they valuable, and are process measures adequate? Curr Opin Infect Dis. 2007;20:182-189.

Lindenauer P, Lagu T, Shieh M, et al. Association of diagnostic coding with trends in hospitalizations and mortality of patients with pneumonia, 2003-2009. JAMA. 2012;307:1405-1413.

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