Skip to main content

Advertisement

SpringerLink
Log in

Factors Associated with Pneumonia Outcomes: A Nationwide Population-Based Study over the 1997–2008 Period

  • Original Research
  • Published:
Journal of General Internal Medicine Aims and scope Submit manuscript

Abstract

BACKGROUND

Pneumonia is the most common infectious cause of death worldwide. Over the last decade, patient characteristics and health care factors have changed. However, little information is available regarding systematically and simultaneously exploring effects of these changes on pneumonia outcomes.

OBJECTIVES

We used nationwide longitudinal population-based data to examine which patient characteristics and health care factors were associated with changes in 30-day mortality rates for pneumonia patients.

DESIGN

Trend analysis using multilevel techniques.

SETTING

General acute care hospitals throughout Taiwan.

PARTICIPANTS

A total of 788,011 pneumonia admissions.

MEASUREMENTS

Thirty-day mortality rates. Taiwan’s National Health Insurance claims data from 1997 to 2008 were used to identify the effects of patient characteristics and health care factors on 30-day mortality rates.

RESULTS

Male, older, or severely ill patients, patients with more comorbidities, weekend admissions, larger reimbursement cuts and lower physician volume were associated with increased 30-day mortality rates. Moreover, there were interactions between patient age and trend on mortality.

CONCLUSIONS

Male, older or severely ill patients with pneumonia have higher 30-day mortality rates. However, mortality gaps between elderly and young patients narrowed over time; namely, the decline rate of mortality among elderly patients was faster than that among young patients. Pneumonia patients admitted on weekends also have higher mortality rates than those admitted on weekdays. The mortality of pneumonia patients rises under increased financial strain from cuts in reimbursement such as the Balanced Budget Act in the United States or global budgeting. Higher physician volume is associated with lower mortality rates.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Figure 1.

Similar content being viewed by others

References

  1. World Health Organization. The top 10 causes of death. Available at: http://www.who.int/mediacentre/factsheets/fs310/en/. Accessed October 31, 2011.

  2. Centers for Disease Control and Prevention. Deaths and mortality. Available at: http://www.cdc.gov/nchs/fastats/deaths.htm. Accessed October 31, 2011.

  3. Agency for Healthcare Research and Quality. Guide to inpatient quality indicators: quality of care in hospitals-volume, mortality, and utilization. Available at: http://www.qualityindicators.ahrq.gov/Modules/iqi_resources.aspx. Accessed October 31, 2011.

  4. Centers for Medicare and Medicaid Services. Mortality measures overview: publicly reporting risk-standardized, 30 day mortality measures for AMI, HF and PN. Available at: http://www.qualitynet.org/dcs/ContentServer?c=Page&pagename=QnetPublic%2FPage%2FQnetTier2&cid=1163010398556. Accessed October 31, 2011.

  5. Department of Health & Human Services. Hospital Compare—a quality tool provided by Medicare. Available at: http://www.hospitalcompare.hhs.gov/Hospital/Search/Welcome.asp?version=default&browser=IE%7C7%7CWinXP&language=English&defaultstatus=0&MBPProviderID=&TargetPage=&ComingFromMBP=&CookiesEnabledStatus=&TID=&StateAbbr=&ZIP=&State=&pagelist=Home. Accessed October 31, 2011.

  6. Marrie TJ, Carriere KC, Jin Y, Johnson DH. Mortality during hospitalisation for pneumonia in Alberta, Canada, is associated with physician volume. Eur Resp J. 2003;22:148–55.

    Article  CAS  Google Scholar 

  7. Bell CM, Redelmeier DA. Mortality among patients admitted to hospitals on weekends as compared with weekdays. N. Engl. J. Med. 2001;345:663–8.

    Article  PubMed  CAS  Google Scholar 

  8. Kostis WJ, Demissie K, Marcella SW, Shao Y-H, Wilson AC, Moreyra AE. Weekend versus weekday admission and mortality from myocardial infarction. N. Engl. J. Med. 2007;356:1099–109.

    Article  PubMed  CAS  Google Scholar 

  9. Seshamani M, Zhu J, Volpp KG. Did postoperative mortality increase after the implementation of the Medicare Balanced Budget Act? Med. Care. 2006;44:527–33.

    Article  PubMed  Google Scholar 

  10. Tung YC, Chang GM. The effect of cuts in reimbursement on stroke outcome: a nationwide population-based study during the period 1998 to 2007. Stroke. 2010;41:504–9.

    Article  Google Scholar 

  11. Agency for Healthcare Research and Quality. Inpatient quality indicators: technical specifications. Available at: http://www.qualityindicators.ahrq.gov/Modules/IQI_TechSpec.aspx. Accessed October 31, 2011.

  12. Bratzler DW, Normand S-LT, Wang Y, et al. An administrative claims model for profiling hospital 30 day mortality rates for pneumonia patients. PLoS One. 2011;6:e17401.

    Article  PubMed  CAS  Google Scholar 

  13. Krumholz HM, Wang Y, Mattera JA, et al. An administrative claims model suitable for profiling hospital performance based on 30 day mortality rates among patients with an acute myocardial infarction. Circulation. 2006;113:1683–92.

    Article  PubMed  Google Scholar 

  14. Mortensen EM, Coley CM, Singer DE, et al. Causes of death for patients with community-acquired pneumonia: results from the Pneumonia Patient Outcomes Research Team cohort study. 2002;162:1059–64.

  15. Lindenauer PK, Behal R, Murray CK, Wato N, Houck PM, Bratzler DW. Volume, quality of care, and outcome in pneumonia. Ann. Intern. Med. 2006;144:262–9.

    PubMed  Google Scholar 

  16. Restrepo MI, Mortensen EM, Rello J, Brody J, Anzueto A. Late admission to the ICU in patients with community-acquired pneumonia is associated with higher mortality. Chest. 2010;137:552–7.

    Article  PubMed  Google Scholar 

  17. Ruhnke GW, Coca-Perraillon M, Kitch BT, Cutler DM. Marked reduction in 30 day mortality among elderly patients with community-acquired pneumonia. Am. J. Med. 2011;124:171–8.

    Article  PubMed  Google Scholar 

  18. Lien HM, Chou SY, Liu JT. Hospital ownership and performance: evidence from stroke and cardiac treatment in Taiwan. J. Health Econ. 2008;27:1208–23.

    Article  PubMed  Google Scholar 

  19. Tung YC, Chang GM, Chen YH. Associations of physician volume and weekend admissions with ischemic stroke outcome in Taiwan: a nationwide population-based study. Med. Care. 2009;47:1018–25.

    Article  PubMed  Google Scholar 

  20. Lin HC, Xirasagar S, Lin HC, Hwang YT. Does physicians’ case volume impact inpatient care costs for pneumonia cases? J. Gen. Intern. Med. 2008;23:304–9.

    Article  PubMed  Google Scholar 

  21. Lin HC, Xirasagar S, Chen CH, Hwang YT. Physician's case volume of intensive care unit pneumonia admissions and in-hospital mortality. Am. J. Respir. Crit. Care Med. 2008;177:989–94.

    Article  PubMed  Google Scholar 

  22. Deyo RA, Cherkin DC, Ciol MA. Adapting a clinical comorbidity index for use with ICD-9-CM administrative databases. J. Clin. Epidemiol. 1992;45:613–9.

    Article  PubMed  CAS  Google Scholar 

  23. Bureau of National Health Insurance. The monetary value of each point under global budgeting. Available at: http://www.nhi.gov.tw/webdata/webdata.aspx?menu=20&menu_id=710&WD_ID=812&webdata_id=3630. Accessed October 31, 2011.

  24. Davis P, Lay-Yee R, Scott A, Gauld R. Do hospital bed reduction and multiple system reform affect patient mortality?: a trend and multilevel analysis in New Zealand over the period 1988–2001. Med. Care. 2007;45:1186–94.

    Article  PubMed  Google Scholar 

  25. Hsueh YS, Lee SY, Huang YT. Effects of global budgeting on the distribution of dentists and use of dental care in Taiwan. Health Serv. Res. 2004;39:2135–53.

    Article  PubMed  Google Scholar 

  26. Learn PA, Bach PB. A decade of mortality reductions in major oncologic surgery: the impact of centralization and quality improvement. Med. Care. 2010;48:1041–9.

    Article  PubMed  Google Scholar 

  27. Rice N, Leyland A. Multilevel models: applications to health data. J Health Serv Policy. 1996;1:154–64.

    CAS  Google Scholar 

  28. Austin PC, Tu JV, Alter DA. Comparing hierarchical modeling with traditional logistic regression analysis among patients hospitalized with acute myocardial infarction: should we be analyzing cardiovascular outcomes data differently? Am. Heart J. 2003;145:27–35.

    Article  PubMed  Google Scholar 

  29. Roux AVD. A glossary for multilevel analysis. J. Epidemiol. Community Health. 2002;56:588–94.

    Article  Google Scholar 

  30. Hox JJ. Multilevel analysis: techniques and applications. Mahwah, NJ: Lawrence Erlbaum Associates; 2002.

    Google Scholar 

  31. Raudenbush SW, Bryk AS. Hierarchical linear models: applications and data analysis methods.. Thousand Oaks: Sage Publications; 2002.

    Google Scholar 

  32. Chen YH, Liou SH, Chou CC, Su WL, Loh CH, Lin SH. Influenza and pneumococcal vaccination of the elderly in Taiwan. 2004;22:2806–11.

  33. Wang ST, Lee LT, Chen LS, Chen TH. Economic evaluation of vaccination against influenza in the elderly: an experience from a population-based influenza vaccination program in Taiwan. 2005;23:1973–80.

  34. Wang CS, Wang ST, Lai CT, Lin LJ, Chou P. Impact of influenza vaccination on major cause-specific mortality. 2007;25:1196–203.

  35. Ruhnke GW, Coca-Perraillon M, Kitch BT, Cutler DM. Trends in mortality and medical spending in patients hospitalized for community-acquired pneumonia: 1993–2005. Med. Care. 2010;48:1111–6.

    Article  PubMed  Google Scholar 

  36. Foss NB, Kehlet H. Short-term mortality in hip fracture patients admitted during weekends and holidays. Br. J. Anaesth. 2006;96:450–4.

    Article  PubMed  CAS  Google Scholar 

  37. Saposnik G, Baibergenova A, Bayer N, Hachinski V. Weekends: a dangerous time for having a stroke? Stroke. 2007;38:1211–5.

    Article  PubMed  Google Scholar 

  38. Chang YC, Li YF, Wang FK, Cheng SH. The impact of global budgeting of National Health Insurance: a preliminary study on dental and primary care facilities. Taiwan J Public Health. 2006;25:152–62.

    Google Scholar 

  39. Aiken LH, Clarke SP, Sloane DM, Sochalski J, Silber JH. Hospital nurse staffing and patient mortality, nurse burnout, and job dissatisfaction. JAMA. 2002;288:1987–93.

    Article  PubMed  Google Scholar 

  40. Needleman J, Buerhaus P, Mattke S, Stewart M, Zelevinsky K. Nurse-staffing levels and the quality of care in hospitals. N. Engl. J. Med. 2002;346:1715–22.

    Article  PubMed  Google Scholar 

  41. Person SD, Allison JJ, Kiefe CI, et al. Nurse staffing and mortality for Medicare patients with acute myocardial infarction. Med. Care. 2004;42:4–12.

    Article  PubMed  Google Scholar 

  42. Estabrooks CA, Midodzi WK, Cummings GG, Ricker KL, Giovannetti P. The impact of hospital nursing characteristics on 30 day mortality. Nurs. Res. 2005;54:74–84.

    Article  PubMed  Google Scholar 

  43. Schilling PL, Campbell DA Jr, Englesbe MJ, Davis MM. A comparison of in-hospital mortality risk conferred by high hospital occupancy, differences in nurse staffing levels, weekend admission, and seasonal influenza. Med. Care. 2010;48:224–32.

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

The study was supported by grants from the National Science Council (NSC97-2410-H-130-011) in Taiwan and is based in part on data from the National Health Insurance Research Database provided by the Bureau of National Health Insurance, Department of Health, and managed by the National Health Research Institutes. The interpretation and conclusions contained herein do not represent those of the Bureau of National Health Insurance, the Department of Health or the National Health Research Institutes.

Conflict of Interest

None disclosed.

Author information

Authors and Affiliations

  1. Department of Family Medicine, Cardinal Tien Hospital, New Taipei City, Taiwan

    Guann-Ming Chang MD MS

  2. Department of Healthcare Information and Management, Ming Chuan University, Room AA611, No. 5, De Ming Rd, Gui Shan District, Taoyuan County, 333, Taiwan

    Yu-Chi Tung PhD

Authors
  1. Guann-Ming Chang MD MS
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Yu-Chi Tung PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Yu-Chi Tung PhD.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Chang, GM., Tung, YC. Factors Associated with Pneumonia Outcomes: A Nationwide Population-Based Study over the 1997–2008 Period. J GEN INTERN MED 27, 527–533 (2012). https://doi.org/10.1007/s11606-011-1932-1

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11606-011-1932-1

KEYWORDS

Search

Navigation