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Research Studies is a monthly compilation of research articles funded by AHRQ or authored by AHRQ researchers and recently published in journals or newsletters.
Results1 to 15 of 15 Research Studies Displayed
Haessler S, Guo N, Deshpande A
Etiology, treatments, and outcomes of patients with severe community-acquired pneumonia in a large U.S. sample.
This study compared the clinical practice and outcomes in severe community-acquired pneumonia (sCAP) patients to those in non-sCAP patients using guideline-defined criteria for sCAP. The definition for sCAP includes a principal diagnosis of pneumonia or a secondary pneumonia diagnosis paired with a principal diagnosis of sepsis or respiratory failure. One-hundred seventy-seven US hospitals within the Premier Healthcare Database were used to identify 154,799 patients with pneumonia, with 14.1% meeting criteria for sCAP. The sCAP patients had higher organ failure scores and inpatient mortality, longer lengths of stay, and higher costs than those with nonsevere disease. Patients with sCAP had twice the rate of positive blood cultures and respiratory cultures and more often had isolates resistant to first-line community-acquired pneumonia antibiotics. The most common pathogen acquired from blood cultures was Streptococcus pneumoniae and from the respiratory tract Staphylococcus aureus and Pseudomonas species. The most common antibiotics prescribed were vancomycin (65%) and piperacillin-tazobactam (42.8%), regardless of cultures positive for a resistant organism.
Citation: Haessler S, Guo N, Deshpande A . Etiology, treatments, and outcomes of patients with severe community-acquired pneumonia in a large U.S. sample. Crit Care Med 2022 Jul;50(7):1063-71. doi: 10.1097/ccm.0000000000005498..
Keywords: Community-Acquired Infections, Pneumonia, Respiratory Conditions, Outcomes
Wang Y, Eldridge N, Metersky ML
AHRQ Author: Eldridge N, Rodrick D
Analysis of hospital-level readmission rates and variation in adverse events among patients with pneumonia in the United States.
The purpose of this AHRQ-authored cross-sectional study was to assess whether patients with pneumonia who were admitted to hospitals with higher risk-standardized readmission rates had a higher risk of in-hospital adverse events. The researchers linked patient-level adverse events data from the Medicare Patient Safety Monitoring System (MPSMS) to the hospital-level pneumonia-specific all-cause readmissions data from the Centers for Medicare & Medicaid Services. The MPSMS data included 46,047 patients with pneumonia across 2,590 hospitals discharged from July 1, 2010, through December 31, 2019. For data from 2010 to 2017, analysis was completed from October 2019 through July 2020, and for data from 2018 to 2019 analysis was completed from March through April 2022. The study concluded that readmission rates are associated with the quality of hospital care for pneumonia; patients with pneumonia admitted to hospitals with high all-cause readmission rates had a higher likelihood of developing adverse events during the initial hospitalization.
AHRQ-authored; AHRQ-funded; 290201800005C.
Citation: Wang Y, Eldridge N, Metersky ML . Analysis of hospital-level readmission rates and variation in adverse events among patients with pneumonia in the United States. JAMA Netw Open 2022 May 2;5(5):e2214586. doi: 10.1001/jamanetworkopen.2022.14586..
Keywords: Hospital Readmissions, Hospitals, Adverse Events, Pneumonia, Respiratory Conditions
Bartley PS, Deshpande A, Yu PC
Bacterial coinfection in influenza pneumonia: rates, pathogens, and outcomes.
Among patients hospitalized for influenza pneumonia, the researchers reported the rate of coinfection and distribution of pathogens and also compared outcomes of patients with and without bacterial coinfection. They found that, in a large US inpatient sample hospitalized with influenza and community-acquired pneumonia, Staphylococcus aureus was the most frequent cause of bacterial coinfection. Coinfection was associated with worse outcomes and higher costs.
Citation: Bartley PS, Deshpande A, Yu PC . Bacterial coinfection in influenza pneumonia: rates, pathogens, and outcomes. Infect Control Hosp Epidemiol 2022 Feb;43(2):212-17. doi: 10.1017/ice.2021.96..
Keywords: Influenza, Pneumonia, Infectious Diseases, Community-Acquired Infections
Rastogi R, Yu PC, Deshpande A
Treatment and outcomes among patients ≥85 years hospitalized with community-acquired pneumonia.
This retrospective cohort study’s objective was to describe community-acquired pneumonia (CAP) among patients ≥85 years and compare them to patients aged 65-74. Findings showed that patients aged 85 and over have different comorbidities and etiologies of CAP, receive less intense treatment, and have greater mortality than patients between 65 and 75 years.
Citation: Rastogi R, Yu PC, Deshpande A . Treatment and outcomes among patients ≥85 years hospitalized with community-acquired pneumonia. J Investig Med 2022 Feb;70(2):376-82. doi: 10.1136/jim-2021-002078..
Keywords: Elderly, Community-Acquired Infections, Pneumonia, Outcomes, Hospitalization
Frush JM, Zhu Y, Edwards KM
Prevalence of staphylococcus aureus and use of antistaphylococcal therapy in children hospitalized with pneumonia.
In a studied group of children hospitalized with community-acquired pneumonia, staphylococcal pneumonia was rare but associated with adverse in-hospital outcomes. Despite this low prevalence, use of antistaphylococcal antibiotics was common. The authors recommended efforts to minimize overuse of antistaphylococcal antibiotics while also ensuring adequate treatment for pathogen-specific diseases.
Citation: Frush JM, Zhu Y, Edwards KM . Prevalence of staphylococcus aureus and use of antistaphylococcal therapy in children hospitalized with pneumonia. J Hosp Med 2018 Dec;13(12):848-52. doi: 10.12788/jhm.3093..
Keywords: Children/Adolescents, Infectious Diseases, Pneumonia, Methicillin-Resistant Staphylococcus aureus (MRSA), Community-Acquired Infections, Hospitalization, Antibiotics, Medication
Heslin KC, Owens PL, Simpson LA
AHRQ Author: Heslin KC Owens PL
Annual report on health care for children and youth in the united states: focus on 30-day unplanned inpatient readmissions, 2009 to 2014.
The authors describe trends in unplanned 30-day all-condition hospital readmissions for children aged 1 to 17 years between 2009 and 2014. Using HCUP data, they found that the rate of readmission was essentially stable between 2009 and 2014. In 2009, the most common reason for readmission was sickle cell anemia, whereas in 2014 the most common reason was epilepsy. Pneumonia fell from the second to the sixth most common reason for readmission over this period. The authors suggest that their study provides a baseline assessment for examining trends in 30-day unplanned pediatric readmissions, an important quality metric as the provisions of the Children's Health Insurance Program Reauthorization Act and the Affordable Care Act are changed and implemented in the future.
Citation: Heslin KC, Owens PL, Simpson LA . Annual report on health care for children and youth in the united states: focus on 30-day unplanned inpatient readmissions, 2009 to 2014. Acad Pediatr 2018 Nov - Dec;18(8):857-72. doi: 10.1016/j.acap.2018.06.006..
Keywords: Healthcare Cost and Utilization Project (HCUP), Children/Adolescents, Hospital Readmissions, Hospitalization, Hospitals, Sickle Cell Disease, Pneumonia, Neurological Disorders
Schmajuk G, Yazdany J
Further lessons in pneumocystis pneumonia prophylaxis.
This paper discusses an teachable moment case study by LoPiccolo, et al, published in 2018 in the Journal of the American Medical Association Internal Medicine, entitled “Corticosteroid Use and Pneumocystis Pneumonia Prophylaxis: A Teachable Moment.”
Citation: Schmajuk G, Yazdany J . Further lessons in pneumocystis pneumonia prophylaxis. JAMA Intern Med 2018 Nov;178(11):1565-66. doi: 10.1001/jamainternmed.2018.5930..
Keywords: Pneumonia, Prevention
Likosky DS, Harrington SD, Cabrera L
Collaborative quality improvement reduces postoperative pneumonia after isolated coronary artery bypass grafting surgery.
This study examined post cardiac surgery pneumonia rates associated with participation in a statewide, quality improvement collaborative relative to a national physician reporting program. The investigators concluded that participation in a physician-led collaborative was associated with significant reductions in pneumonia relative to a national quality reporting program. They suggest that interventions including collaborative learning may yield superior outcomes relative to solely using physician feedback reporting.
Citation: Likosky DS, Harrington SD, Cabrera L . Collaborative quality improvement reduces postoperative pneumonia after isolated coronary artery bypass grafting surgery. Circ Cardiovasc Qual Outcomes 2018 Nov;11(11):e004756. doi: 10.1161/circoutcomes.118.004756..
Keywords: Outcomes, Patient Safety, Pneumonia, Quality of Care, Quality Improvement, Surgery
Weir RE, Lyttle CS, Meltzer DO
The relative ability of comorbidity ascertainment methodologies to predict in-hospital mortality among hospitalized community-acquired pneumonia patients.
In this observational study, the investigators sought to compare the relative value of several methodologies by which comorbidities may be ascertained. The authors concluded that although comorbidities derived through administrative data did produce an area under the curve greater than chart review, their analyses suggested a coding bias in several comorbidities with a paradoxically protective effect. They assert that chart review, while labor and resource intensive, may be the ideal method for ascertainment of clinically relevant comorbidities.
AHRQ-funded; HS016948; HS010597.
Citation: Weir RE, Lyttle CS, Meltzer DO . The relative ability of comorbidity ascertainment methodologies to predict in-hospital mortality among hospitalized community-acquired pneumonia patients. Med Care 2018 Nov;56(11):950-55. doi: 10.1097/mlr.0000000000000989..
Keywords: Community-Acquired Infections, Hospitalization, Mortality, Pneumonia
Desai NR, Ott LS, George EJ
Variation in and hospital characteristics associated with the value of care for Medicare beneficiaries with acute myocardial infarction, heart failure, and pneumonia.
The objectives of this study were to investigate the association between hospital-level 30-day risk-standardized mortality rates (RSMRs) and 30-day risk-standardized payments (RSPs) for acute myocardial infarction (AMI), heart failure (HF), and pneumonia (PNA); to characterize patterns of value in care; and to identify hospital characteristics associated with high-value care (defined by having lower than median RSMRs and RSPs).
Citation: Desai NR, Ott LS, George EJ . Variation in and hospital characteristics associated with the value of care for Medicare beneficiaries with acute myocardial infarction, heart failure, and pneumonia. JAMA Netw Open 2018 Oct 5;1(6):e183519. doi: 10.1001/jamanetworkopen.2018.3519..
Keywords: Cardiovascular Conditions, Elderly, Hospitalization, Hospitals, Heart Disease and Health, Inpatient Care, Medicare, Mortality, Pneumonia, Value
Thompson MP, Cabrera L, Strobel RJ
Association between postoperative pneumonia and 90-day episode payments and outcomes among Medicare beneficiaries undergoing cardiac surgery.
Postoperative pneumonia is the most common healthcare-associated infection in cardiac surgical patients, yet their impact across a 90-day episode of care remains unknown. The objective of this study was to examine the relationship between pneumonia and 90-day episode payments and outcomes among Medicare beneficiaries undergoing cardiac surgery. The investigators concluded that postoperative pneumonia was associated with significantly higher 90-day episode payments and inferior outcomes at the patient and hospital level.
Citation: Thompson MP, Cabrera L, Strobel RJ . Association between postoperative pneumonia and 90-day episode payments and outcomes among Medicare beneficiaries undergoing cardiac surgery. Circ Cardiovasc Qual Outcomes 2018 Sep;11(9):e004818. doi: 10.1161/circoutcomes.118.004818..
Keywords: Elderly, Surgery, Medicare, Cardiovascular Conditions, Heart Disease and Health, Pneumonia, Payment, Healthcare Costs, Outcomes, Healthcare-Associated Infections (HAIs), Health Insurance
Reeves SL, Tribble AC, Madden B
Antibiotic prophylaxis for children with sickle cell anemia.
This study calculated the proportion of children with sickle cell anemia (SCA) who received at least 300 days of antibiotic prophylaxis against invasive pneumococcal disease and identified predictors of receipt. Children with SCA between 3 months and 5 years old were identified by the presence of three or more Medicaid claims with a diagnosis of SCA within a calendar year in six states. Receipt of antibiotics was identified through claims for filled prescriptions. The authors conclude that antibiotic prophylaxis rates are low among children with SCA; more healthcare encounters may offer opportunities for increased intervention. Potential predictors were identified as age, sex, year, state, and health services usage.
Citation: Reeves SL, Tribble AC, Madden B . Antibiotic prophylaxis for children with sickle cell anemia. Pediatrics 2018 Mar;141(3). doi: 10.1542/peds.2017-2182..
Keywords: Sickle Cell Disease, Children/Adolescents, Antibiotics, Prevention, Pneumonia, Medication
Eisler L, Huang G, Lee KM
Identification of perioperative pulmonary aspiration in children using quality assurance and hospital administrative billing data.
This study aims to identify the incidence of and risk factors for perioperative aspiration in children using quality assurance data supplemented by administrative billing records, and to examine the utility of billing data as a supplementary data source. The investigators found that International Classification of Diseases, Ninth Revision codes for aspiration used as a secondary data source were nonspecific for perioperative aspiration, but when combined with record review yielded a 30% increase in identified cases of aspiration over quality assurance data alone.
Citation: Eisler L, Huang G, Lee KM . Identification of perioperative pulmonary aspiration in children using quality assurance and hospital administrative billing data. Paediatr Anaesth 2018 Mar;28(3):218-25. doi: 10.1111/pan.13319..
Keywords: Adverse Events, Children/Adolescents, Data, Pneumonia, Respiratory Conditions
Brescia AA, Rankin JS, Cyr DD
Determinants of variation in pneumonia rates after coronary artery bypass grafting.
In this study, investigators determined to what extent patient risk factors account for hospital variation in pneumonia rates. Their findings suggested that patient risk profiles only account for a fraction of hospital variation in pneumonia rates. The investigators assert that enhanced understanding of other contributory factors (eg, processes of care) is required to lessen the likelihood of such nosocomial infections.
Citation: Brescia AA, Rankin JS, Cyr DD . Determinants of variation in pneumonia rates after coronary artery bypass grafting. Ann Thorac Surg 2018 Feb;105(2):513-20. doi: 10.1016/j.athoracsur.2017.08.012..
Keywords: Adverse Events, Cardiovascular Conditions, Pneumonia, Surgery
DeWaters AL, Chansard M, Anzueto A
The association between major depressive disorder and outcomes in older veterans hospitalized with pneumonia.
The aim of this study was to examine the association between depression and outcomes, including mortality and intensive care unit admission, in veterans hospitalized with pneumonia. It found that patients with untreated depression had a significantly higher 30-day and 90-day mortality, as well as significantly higher intensive care unit admission rates, compared to patients with treated depression.
Citation: DeWaters AL, Chansard M, Anzueto A . The association between major depressive disorder and outcomes in older veterans hospitalized with pneumonia. Am J Med Sci 2018 Jan;355(1):21-26. doi: 10.1016/j.amjms.2017.08.015.
Keywords: Depression, Hospitalization, Patient-Centered Outcomes Research, Pneumonia, Veterans