Hospitalized pneumonia |
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Authors: | Judith R Lave PhD Michael J Fine MD MSc Steadman S Sankey MS Barbara H Hanusa PhD Lisa A Weissfeld PhD Wishwa N Kapoor MD MPH |
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Institution: | (1) the Department of Health Services Administration, Graduate School of Public Health, USA;(2) Department of Biostatistics, Graduate School of Public Health, USA;(3) Division of General Internal Medicine, Department of Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, Pa;(4) Room A649, Graduate School of Public Health, University of Pittsburgh, 130 DeSoto St., 15261 Pittsburgh, PA |
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Abstract: | OBJECTIVES: To describe discharge rates, geographic and patient characteristics, treatment patterns, costs, and outcomes of patients
hospitalized with community-acquired pneumonia (CAP) in Pennsylvania hospitals and compare these patients from rural and urban
counties.
DESIGN: A retrospective database study.
PATIENTS: Adult patients (age ≥18) with an ICD-9-CM diagnosis of pneumonia discharged from 193 Pennsylvania hospitals (n=36,222) in 1991 from the MediQual Systems Pennsylvania database.
MEASUREMENTS: Patient characteristics included a pneumonia-specific severity index, microbiologic etiology, and a number of comorbid conditions.
Treatment indicators included the specialty of the admitting physician, length of stay, admittance to an intensive care unit,
and mechanical ventilation. Cost indicators included charges and estimated costs. Outcomes measured were inpatient mortality
and discharge disposition. Counties in Pennsylvania were classified into seven urban or rural groups, and patients were classified
by the county of residence.
RESULTS: The discharge rate for CAP was 4.0 per 1,000 and did not vary systematically across urban or rural counties. Most patients
were treated in local hospitals. The average distance between residence and hospital was 5.4 miles and varied with urban or
rural classification (range 2.5–9.3 miles). Among CAP patients, 37.8% were at low risk of mortality, with no systematic differences
across rural or urban patients with respect to pneumonia severity. Rural patients were more likely to be treated by a family
physician and somewhat less likely to be admitted to an intensive care unit or to be mechanically ventilated. Costs of treating
rural patients were lower. In-hospital mortality rates, with controls for admission severity, were comparable or better for
rural patients than for urban patients.
CONCLUSIONS: Patients with CAP are treated in hospitals located in counties similar to ones in which they reside. The cost of treatment
was lower for rural patients than for urban patients, but outcomes were not different.
This work was funded in part by the Agency for Health Care Policy and Research (R01 HSO 6468) as part of the Pneumonia Patient
Outcomes Research Team (PORT) Project. Dr. Fine is supported in part as a Robert Wood Johnson Foundation Generalist Faculty
Scholar. |
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Keywords: | community-acquired pneumonia rural and urban hospitalized patients cost of treatment outcomes |
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