Pneumonia is a severe condition with health care associated pneumonia responsible for significant morbitidy, mortality and cost of care. Given the impact of high readmission rates with the threat of reduced reimbursements and with goals of zero hospital associated harm, it is important to identify patients at highest risk of readmission. The purpose of our study was to investigate in a large multicenter cohort over a several year period, the association of specific risk factors with 30-day readmission in patients presenting with health-care associated pneumonia (HCAP).
This is a retrospective multicenter analysis of patients with pneumonia over an 11-year period from 4 large health care institutions. Participating centers included Henry Ford Health System, University of Maryland Medical System, Baylor Health Care System and Barnes Jewish Hospital. Patients were identified by diagnostic codes. Specifically, HCAP patients were identified as those who received an antipseudomonal beta-lactam or linezolid in the first 24 hours of hospitalization. A computer stores generated database was used to obtain demographic data including age, sex, cultured organism, Charlson comorbidity index, length of stay (LOS) and therapy.
There were 12,947 patients classified as HCAP who did not expire during initial hospitalization. 24.42% were readmitted for any cause within 30 days. Those readmitted were found to have significantly longer hospital initial LOS (17.2 vs 15.2 days, p <0.001), higher Charlson co-morbidity index (4.0 vs 3.7, p<0.001), and older age (over 60 years p<0.001). Organisms associated with higher readmission rates included MRSA, Klebsiella sp and P. aeruginosa (p<0.001). Patients having HCAP without sputum obtained and organism identification had lower readmission rates (p<0.001).
The results of our multicenter study suggest that HCAP patients with more comorbid conditions have increased risk of 30-day readmission rates. Organism identification was helpful in patients at higher risk of readmission. However, those without organisms identified had less readmissions suggesting appropriate coverage by current HCAP regimens. Identifying high risk patients early on should prompt more aggressive discharge follow up, patient education, and culture screening to potentially reduce readmissions.
R. Bajoka, pfuzer: Investigator , Research support
D. Moreno, pfizer: Investigator , Research support
A. D. Harris, pfizer: Investigator , Research support
S. J. Lawrence, Merck: Consultant , Consulting fee
pfizer: Investigator , Research support
A. Masica, pfizer: Investigator , Research support
L. Lamerato, pfizer: Investigator , Research support
M. Zervos, Pfizer: Principle investigator , Research grant to Henry Ford Hospital
Cerexa: Principle investigator , Research grant to Henry Ford Hospital
Tetraphase: Principle investigator , Research grant to Henry Ford Hospital