A six-year epidemiologic review of pneumonia in Department of Veterans Affairs facilities

Objective: Pneumonia and acute lower respiratory infections are a major pro blem in the United States and worldwide. As one of the largest health care organizations in the United States, the Department of Veterans Affairs is a n Ideal location for an epidemiologic review of pneumonia over an extended period of time. Methods: Data for this study were retrieved from the Depart ment of Veterans Affairs Austin Automation Center, the central repository f or patient data in the Veterans Health Administration (VHA). In addition, s pecific data regarding penicillin-resistant Streptococcus pneumoniae in VHA facilities were obtained from an annual electronic nationwide census. Resu lts: The case rate of pneumonias as a discharge diagnosis increased during the 6-year period. For the diagnosis group of bronchopneumonia and pneumoni a with organism unspecified, the largest subset examined, total numbers and rates for this specific diagnosis increased during the study period. When fiscal year (FY)91 and FY96 were compared, rates increased for three diagno ses: overall pneumonia, pneumonia in infectious diseases classified elsewhe re, and pneumococcal pneumonia. Decreases in rates occurred between FY91 an d FY96 for pneumonia caused by other specified organisms and other bacteria l pneumonia. The total number of discharges from VHA facilities decreased d uring the 6-year period. Conclusions: The numbers of episodes of bronchopne umonia and pneumonia with organism unspecified, the largest pneumonia subse t, increased during the 6-year period to greater than 27,000 cases. As the number of total discharges from the VHA decreased, the combination of incre asing actual numbers and decreasing discharges yielded increased rates for overall pneumonia and certain subsets. These data should be useful in devel oping aggressive preventive strategies.