Temporal trends in outcomes of older patients with pneumonia

Background: It is unclear how outcomes of care for patients hospitalized fo r pneumonia have changed as patterns of health care delivery have changed d uring the 1990s. This study was performed to determine trends in outcomes o f care for older patients hospitalized for pneumonia. Methods: This retrospective analysis was based on Medicare claims and inclu ded most patients with pneumonia who were older than 65 years and admitted to acute care hospitals in Connecticut between October 1, 1991, and Septemb er 30, 1997 (fiscal years 1992-1997). We assessed the trends in hospital co sts, discharge destination, hospital mortality rates, mortality rates withi n 30 days of discharge, and 30-day readmission rates for pneumonia. Multiva riate logistic regression analyses were used to adjust for differences in p atient characteristics. Results: The mean (+/- SD) length of stay declined from 11.9+/-11.4 days to 7.7+/-7.2 days between 1992 and 1997. During this period, adjusted in-hosp ital mortality rates declined (P=.02), while the adjusted risk of discharge to a nursing facility increased (P<.001) and the adjusted risk of hospital readmission for pneumonia within 30 days of discharge increased (P=.05). T he adjusted risk of death 30 days after discharge increased, although the d ifference was not statistically significant (P=.09). Conclusions: Between 1992 and 1997, the adjusted risks of mortality after d ischarge, placement in a nursing facility, and hospital readmission for pne umonia increased among older patients hospitalized for pneumonia, in associ ation with a decline in mean hospital length of stay. These findings raise the question of whether the declining hospital length of stay has negativel y affected patient outcomes.