The Impact of Principal Diagnosis on Readmission Risk among Patients Hospitalized for Community-Acquired Pneumonia

2022 ◽  
Vol Publish Ahead of Print ◽  
Author(s):  
Gregory W. Ruhnke ◽  
Peter K. Lindenauer ◽  
Christopher S. Lyttle ◽  
David O. Meltzer
Keyword(s):  
Community Acquired Pneumonia ◽  
Principal Diagnosis ◽  
The Impact ◽  
Readmission Risk

scholarly journals Influenza With an Infiltrate: Investigating the New Community-Acquired Pneumonia Guidelines

2020 ◽  
Vol 41 (S1) ◽  
pp. s302-s302
Author(s):  
Amanda Barner ◽  
Lou Ann Bruno-Murtha
Keyword(s):  
Demographic Data ◽  
Retrospective Chart Review ◽  
Vaccination Rate ◽  
Community Acquired Pneumonia ◽  
Teaching Hospitals ◽  
Antibiotic Prescribing ◽  
Supporting Evidence ◽  
Radiographic Findings ◽  
Significant Difference ◽  
The Impact

Background: The Infectious Diseases Society of America released updated community-acquired pneumonia (CAP) guidelines in October 2019. One of the recommendations, with a low quality of supporting evidence, is the standard administration of antibiotics in adult patients with influenza and radiographic evidence of pneumonia. Procalcitonin (PCT) is not endorsed as a strategy to withhold antibiotic therapy, but it could be used to de-escalate appropriate patients after 48–72 hours. Radiographic findings are not indicative of the etiology of pneumonia. Prescribing antibiotics for all influenza-positive patients with an infiltrate has significant implications for stewardship. Therefore, we reviewed hospitalized, influenza-positive patients at our institution during the 2018–2019 season, and we sought to assess the impact of an abnormal chest x-ray (CXR) and PCT on antibiotic prescribing and outcomes. Methods: We conducted a retrospective chart review of all influenza-positive admissions at 2 urban, community-based, teaching hospitals. Demographic data, vaccination status, PCT levels, CXR findings, and treatment regimens were reviewed. The primary outcome was the difference in receipt of antibiotics between patients with a negative (<0.25 ng/mL) and positive PCT. Secondary outcomes included the impact of CXR result on antibiotic prescribing, duration, 30-day readmission, and 90-day mortality. Results: We reviewed the medical records of 117 patients; 43 (36.7%) received antibiotics. The vaccination rate was 36.7%. Also, 11% of patients required intensive care unit (ICU) admission and 84% received antibiotics. Moreover, 109 patients had a CXR: 61 (55.9%) were negative, 29 (26.6%) indeterminate, and 19 (17.4%) positive per radiologist interpretation. Patients with a positive PCT (OR, 12.7; 95% CI, 3.43–60.98; P < .0007) and an abnormal CXR (OR, 7.4; 95% CI, 2.9–20.1; P = .000003) were more likely to receive antibiotics. There was no significant difference in 30-day readmission (11.6% vs 13.5%; OR, 0.89; 95% CI, 0.21–3.08; P = 1) and 90-day mortality (11.6% vs 5.4%; OR, 2.37; 95% CI, 0.48–12.75; P = .28) between those that received antibiotics and those that did not, respectively. Furthermore, 30 patients (62.5%) with an abnormal CXR received antibiotics and 21 (43.7%) had negative PCT. There was no difference in 30-day readmission or 90-day mortality between those that did and did not receive antibiotics. Conclusions: Utilization of PCT allowed selective prescribing of antibiotics without impacting readmission or mortality. Antibiotics should be initiated for critically ill patients and based on clinical judgement, rather than for all influenza-positive patients with CXR abnormalities.Funding: NoneDisclosures: None

Clinical Impact of Combined Viral and Bacterial Infection in Pediatric Mycoplasmal Community-Acquired Pneumonia in Western China

2020 ◽  
Vol 12 (11) ◽  
pp. 1315-1322
Author(s):  
Zhuoxin Liang ◽  
Wenqiang Zhang ◽  
Yongjiang Jiang ◽  
Ping Wu ◽  
Senxiong Zhang ◽  
...  
Keyword(s):  
Clinical Characteristics ◽  
Severe Disease ◽  
Lung Parenchyma ◽  
Community Acquired Pneumonia ◽  
Western China ◽  
Care Hospital ◽  
Hospital Data ◽  
Chest X Ray ◽  
Ventilation Rates ◽  
The Impact

Community-acquired pneumonia (CAP) refers to an infection contracted outside the hospital that leads to lung parenchyma inflammation. The clinical characteristics of Mycoplasma pneumoniae (M. pneumoniae) infection in CAP patients were rarely reported. The aim of this study was to describe the clinical characteristic and the impact of co-infections of M. pneumoniae with viral and bacterial pathogens in hospitalized children with CAP in Liuzhou, China. This study retrospects children diagnosed with CAP due to M. pneumoniae infection at a tertiary maternal and child health care hospital. Data related to co-infection pathogens, demographics, clinical characteristics, and hospitalization cost were collected from the electronic medical system in this hospital. A total of 983 children were diagnosed with mycoplasmal CAP in 2017. Among them, 18.2% had a bacterial-M. pneumoniae co-infection and 11.3% had a viral-M. pneumoniae co-infection. The highest infection rate of M. pneumoniae was 19.1% in February and March, while the highest rates of bacterial-M. pneumoniae and viral-M. pneumoniae co-infections were 3.6% in December and 2.3% in January, respectively. The prevalence of coughing and wheezing had significant differences between the bacterial- or viral-M. pneumoniae co-infections and the mono-infection groups. Furthermore, the chest X-ray progression, pleural effusions, respiratory failure, and ventilation rates were higher in the respiratory viral- and bacterial-M. pneumoniae co-infection groups than in the mono-infection group. Children with a bacterial or respiratory viral co-infection had a longer hospitalization and spent more on treatment fees than those with a M. pneumoniae mono-infection (P value <0.001). We conclude that children with mycoplasmal CAP, either with a bacterial or viral co-infection, who show signs of coughing and wheezing and have a radiographic progression, will have a severe disease progression and should be specifically treated and managed.

Use of a Structured Panel Process to Define Quality Metrics for Antimicrobial Stewardship Programs

2012 ◽  
Vol 33 (5) ◽  
pp. 500-506 ◽  
Author(s):  
Andrew M. Morris ◽  
Stacey Brener ◽  
Linda Dresser ◽  
Nick Daneman ◽  
Timothy H. Dellit ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Antimicrobial Stewardship ◽  
Bloodstream Infections ◽  
The United States ◽  
Community Acquired Pneumonia ◽  
Public Reporting ◽  
Modified Delphi ◽  
Number Of Patients ◽  
Days Of Therapy ◽  
The Impact

Introduction.Antimicrobial stewardship programs are being implemented in health care to reduce inappropriate antimicrobial use, adverse events, Clostridium difficile infection, and antimicrobial resistance. There is no standardized approach to evaluate the impact of these programs.Objective.To use a structured panel process to define quality improvement metrics for evaluating antimicrobial stewardship programs in hospital settings that also have the potential to be used as part of public reporting efforts.Design.A multiphase modified Delphi technique.Setting.Paper-based survey supplemented with a 1-day consensus meeting.Participants.A 10-member expert panel from Canada and the United States was assembled to evaluate indicators for relevance, effectiveness, and the potential to aid quality improvement efforts.Results.There were a total of 5 final metrics selected by the panel: (1) days of therapy per 1000 patient-days; (2) number of patients with specific organisms that are drug resistant; (3) mortality related to antimicrobial-resistant organisms; (4) conservable days of therapy among patients with community-acquired pneumonia (CAP), skin and soft-tissue infections (SSTI), or sepsis and bloodstream infections (BSI); and (5) unplanned hospital readmission within 30 days after discharge from the hospital in which the most responsible diagnosis was one of CAP, SSTI, sepsis or BSI. The first and second indicators were also identified as useful for accountability purposes, such as public reporting.Conclusion.We have successfully identified 2 measures for public reporting purposes and 5 measures that can be used internally in healthcare settings as quality indicators. These indicators can be implemented across diverse healthcare systems to enable ongoing evaluation of antimicrobial stewardship programs and complement efforts for improved patient safety.

THE IMPACT OF OUTPATIENT INHALED CORTICOSTEROID THERAPY ON DISEASE SEVERITY IN HOSPITALIZED PATIENTS WITH COMMUNITY ACQUIRED PNEUMONIA

CHEST Journal ◽  
2008 ◽  
Vol 134 (4) ◽  
pp. 16S
Author(s):  
Rosa Malo de Molina ◽  
Eric M. Mortensen ◽  
Patricia Castellanos-Matteus ◽  
Antonio Anzueto ◽  
Marcos I. Restrepo
Keyword(s):  
Disease Severity ◽  
Corticosteroid Therapy ◽  
Community Acquired Pneumonia ◽  
Hospitalized Patients ◽  
Inhaled Corticosteroid ◽  
The Impact

scholarly journals Markers of neutrophil extracellular traps predict adverse outcome in community-acquired pneumonia: secondary analysis of a randomised controlled trial

2018 ◽  
Vol 51 (4) ◽  
pp. 1701389 ◽  
Author(s):  
Fahim Ebrahimi ◽  
Stavros Giaglis ◽  
Sinuhe Hahn ◽  
Claudine A. Blum ◽  
Christine Baumgartner ◽  
...  
Keyword(s):  
Hospital Stay ◽  
Secondary Analysis ◽  
Length Of Hospital Stay ◽  
Neutrophil Extracellular Traps ◽  
Community Acquired Pneumonia ◽  
Extracellular Traps ◽  
Clinical Instability ◽  
Randomised Controlled ◽  
The Impact ◽  
Clinical Stability

Neutrophil extracellular traps (NETs) are a hallmark of the immune response in inflammatory diseases. However, the role of NETs in community-acquired pneumonia (CAP) is unknown. This study aims to characterise the impact of NETs on clinical outcomes in pneumonia.This is a secondary analysis of a randomised controlled, multicentre trial. Patients with CAP were randomly assigned to either 50 mg prednisone or placebo for 7 days. The primary end-point was time to clinical stability; main secondary end-points were length of hospital stay and mortality.In total, 310 patients were included in the analysis. Levels of cell-free nucleosomes as surrogate markers of NETosis were significantly increased at admission and declined over 7 days. NETs were significantly associated with reduced hazards of clinical stability and hospital discharge in multivariate adjusted analyses. Moreover, NETs were associated with a 3.8-fold increased adjusted odds ratio of 30-day mortality. Prednisone treatment modified circulatory NET levels and was associated with beneficial outcome.CAP is accompanied by pronounced NET formation. Patients with elevated serum NET markers were at higher risk for clinical instability, prolonged length of hospital stay and 30-day all-cause mortality. NETs represent a novel marker for outcome and a possible target for adjunct treatments of pneumonia.

Abstract 186: Improving Identification and Assessment of Readmission Risk for Acute Myocardial Infarction and Heart Failure Patients Following Implementation of a National Quality Improvement Program

2018 ◽  
Vol 11 (suppl_1) ◽  
Author(s):  
Ty J Gluckman ◽  
Nancy M Albert ◽  
Robert L McNamara ◽  
Gregg C Fonarow ◽  
Adnan Malik ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Heart Failure ◽  
Acute Myocardial Infarction ◽  
Quality Improvement ◽  
Improvement Program ◽  
Patient Level ◽  
Transition Care ◽  
National Quality ◽  
The Impact ◽  
Readmission Risk

Background: Optimal transition care represents an important step in mitigating the risk of early hospital readmission. For many hospitals, however, resources are not available to support transition care processes, and hospitals may not be able to identify patients in greatest need. It remains unknown whether a coordinated quality improvement campaign could help to increase a) identification of at-risk patients and b) use of a readmission risk score to identify patients needing extra services/resources. Methods: The American College of Cardiology Patient Navigator Program was designed as a 2-year (2015-2017) quality improvement campaign to assess the impact of transition-care interventions on transition care performance metrics for patients with acute myocardial infarction (AMI) and heart failure (HF) at 35 acute care hospitals. All sites were active participants in the NCDR ACTION Registry. Facilities were free to choose their transition care priorities, with at least 3 goals established at baseline. Pre-discharge identification of AMI and HF patients and assessment of their respective readmission risk were 4 of the 36 metrics tracked quarterly. Performance reports were provided regularly to the individual institutions. Sharing of best practices was actively encouraged through webinars, a listserv, and an online dashboard with display of blinded performance for all 35 hospitals. Results: At baseline, 31% (11/35) and 23% (8/35) of facilities did not have a process for prospectively identifying AMI and HF patients, respectively. At 2 years, the rate of not having processes decreased to 8% (3/35) and 3% (1/35), respectively. Among hospitals able to identify AMI and HF patients, there was high patient-level identification performance from the outset (91% for AMI and 86% for HF at baseline), with added improvement over 2 years (+2.2% for AMI and +9.3% for HF). At baseline, processes to assess readmission risk for AMI and HF patients were only completed by 26% (9/35) and 31% (11/35) of facilities, respectively. At 2 years, AMI and HF readmission risk assessment rose to 80% (28/35) and 86% (30/35), respectively. Similar improvements were noted at the patient-level, with 34% (52% --> 86%) and 16% (75% --> 91%) absolute 2-year increases in the percentage of AMI and HF patients undergoing assessment of readmission risk, respectively. Conclusions: Implementation of a quality improvement campaign focused on care transition can substantially improve prospective identification of AMI and HF patients and assessment of their readmission risk. It remains to be determined whether process improvement lead to reduction in 30-day readmission and/or improvement in other clinically important outcome measures.

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