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Readmission more likely after health care-associated pneumonia
Patients who had been hospitalized with health care-associated pneumonia were more likely to be readmitted than patients who had community-acquired pneumonia, according to data published in Clinical Infectious Diseases.
“At present, CMS fails to distinguish between community-acquired and health care-associated pneumonia in its efforts to decline payment for readmissions,” Andrew Shorr, MD, MPH, associate section director of pulmonary critical care at the Washington Hospital Center, Washington, D.C., told Infectious Disease News. “This is clearly myopic and penalizes physicians and hospitals inappropriately without addressing the key issues.”
Shorr and colleagues identified adults who were admitted to one index hospital in 2010 with non-nosocomial pneumonia and survived to discharge. They evaluated the number of readmissions to the index hospital or others in the health care system in the 30 days after discharge.
The cohort included 977 patients, and of the 771 who survived to discharge, 149 (19.3%) were readmitted within 30 days. The most common reasons for readmission were chronic obstructive pulmonary disease and congestive heart failure, but 11 patients (7.4%) were diagnosed with pneumonia. There was no difference in demographics, severity of illness or inappropriate use of antibiotics between patients who were readmitted and patients who were not.
The readmission rate for patients who had community-acquired pneumonia was 4.1% vs. 24.4% for those with health care-associated pneumonia: Patients with health care-associated pneumonia were 7.5 times more likely to be readmitted (95% CI, 3.6-15.7). Among those with health care-associated pneumonia, admission from long-term care, immunosuppression, prior antibiotics and prior hospitalization were associated with readmission.
“The key driver of readmission appears to be where the patient came from (eg, a nursing home), as opposed to a variable that physicians might be able to control,” Shorr said. “I do not think that these findings are surprising, and I hope that they help in the discharge planning process and affect policy-making.”
Disclosure: Shorr reports financial relationships with Astellas, Bayer, Cardeas, Cubist, Forest, Pfizer, Theravance and Trius.