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Resource Utilization of Adults Admitted to a Large Urban Hospital With Community-Acquired Pneumonia Caused by Streptococcus pneumoniae: Summary

Published in Pulmonary Function

Excluding those patients who died, median length of stay was 2 days longer in patients who met our definition of delayed discharge. If patients were discharged within 1 day of meeting our clinical definition and receiving oral antibiotic therapy, the median length of stay for these 88 patients would have been 3 days (range, 2 to 6.75 days), with an estimated savings of approximately $507,000. These potential savings are likely underestimated given there was often a delay between IV-to-oral transition and the first day of stable clinical criteria; furthermore, we conservatively used the later day to define discharge eligibility. Our study was conducted at a single hospital, and while our patient population is likely similar to other large urban hospitals in the United States, one study has documented the distinct differences in clinical criteria used by physicians from institution to institution to determine when patients are stable for discharge, which may have influenced the impact of this variable. Additionally, clinical outcomes have not been adversely affected by decreases in length of stay (ie, discharge once patients are clinically stable without observation), suggesting that patients with CAP admitted to hospitals with historically long lengths of stay might be treated just as effectively with shorter hospital stays. It is important to note the limitations in attempting to define this variable retrospectively.

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Resource Utilization of Adults Admitted to a Large Urban Hospital With Community-Acquired Pneumonia Caused by Streptococcus pneumoniae: Recommendation

Published in Pulmonary Function

Resource Utilization of Adults Admitted to a Large Urban Hospital With Community-Acquired Pneumonia Caused by Streptococcus pneumoniae: RecommendationThe present results do confirm findings from other studies demonstrating that hospital bed costs are the major contributor to total costs for CAP. In the study by Klepser et al, room costs accounted for 34% of total hospital costs and nursing costs accounted for 37%. Although we were not able to separate nursing costs from that of room costs in our study, our hospital bed costs accounted for both direct and indirect fixed costs. When added together, the percentage of resources dedicated to room and nursing was similar with our reported hospital bed cost percentage of 55.6%. Likewise, in a separate study to assess resource utilization in the treatment of CAP, Orrick and colleagues found median costs to be $2,430 for their population, with hospital room costs constituting 83.7% of total costs, followed by antibiotic (4.6%), radiology (2.6%), and respiratory care (0.9%) costs. It is not surprising then that admission to an ICU in our study was significantly associated with an increased cost and length of stay, as daily bed cost and total length of stay (11 days vs 5 days, p < 0.001) were both greater for patients in the ICU compared with a normal hospital bed. Importantly, these data taken together confirm that antibiotic costs account for only a small percentage (< 5%) of total costs in the treatment of hospitalized patients with CAP; moreover, any efforts to reduce total or ICU length of stay, such as IV-to-oral transition or clinical pathways, will have the most profound effect on reducing the economic burden of CAP.
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Resource Utilization of Adults Admitted to a Large Urban Hospital With Community-Acquired Pneumonia Caused by Streptococcus pneumoniae: Conclusion

Published in Pulmonary Function

These results conflict with other studies that have identified increased costs attributed to infection with numerous resistant organisms, including S pneumoniae. In particular, our results conflict with a retrospective, cohort study of similar size but different time period by Klepser and colleagues; these investigators evaluated health-care resource utilization for the treatment of penicillin-susceptible and penicillin-nonsusceptible isolates of S pneumoniae and found that total hospitalization costs were significantly greater for patients infected with penicillin nonsusceptible isolates ($10,309.25 vs $7,801.54, p = 0.0006). The primary reason for the higher cost was a greater length of stay among the nonsusceptible group (14 days vs 10 days, p < 0.05). Length of stay in general was much lower for patients in our study (median, 5 days) and not different between susceptible and nonsusceptible groups. It is most likely that the advances in understanding the time frame and clinical characteristics of the stable CAP patient in the current era (2000 to present) have dramatically reduced the duration of hospital stay compared with when the study by Klepser et al was conducted (1995 to 1998), therefore making it more difficult to find a difference if one were to exist. canadian neighbor pharmacy
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Resource Utilization of Adults Admitted to a Large Urban Hospital With Community-Acquired Pneumonia Caused by Streptococcus pneumoniae: Discussion

Published in Pulmonary Function

Resource Utilization of Adults Admitted to a Large Urban Hospital With Community-Acquired Pneumonia Caused by Streptococcus pneumoniae: DiscussionEighty-eight patients (52%) in our cohort met the definition of unexplained delayed discharge. Excluding patients who died in the hospital, the median length of stay was significantly longer in patients with unexplained delayed discharge: 7 days (25th to 75th percentile, 4 to 11 days) vs 5 days (25th to 75th percentile, 3.25 to 7 days) [p = 0.005]. There was no apparent difference in age, comorbidities, or PSI score among patients meeting the definition of unexplained delayed discharge and those who did not. Additionally, penicillin susceptibility had no effect on patients with unexplained delayed discharge (p = 0.847). The addition of delayed discharge improved the coefficient of determination (r2) significantly in both models. http://medicine-against-diabetes.net/
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Resource Utilization of Adults Admitted to a Large Urban Hospital With Community-Acquired Pneumonia Caused by Streptococcus pneumoniae: Research

Published in Pulmonary Function

Only one patient received IV penicillin G, and the majority of (3-lactam use was cefuroxime, ceftriaxone, or cefepime. Eighty-three patients (49.4%) received an oral antibiotic during their hospital stay for the treatment of CAP, with all but two being transitioned from an IV regimen. A greater percentage of patients in the penicillin-susceptible group were transitioned from IV to oral compared with the nonsusceptible group, but the difference did not reach statistical significance (53.2% vs 38.6%, p = 0.137). For those patients who received oral therapy during hospitalization, the median day to transition was day 5 (25th to 75th percentile, day 4 to day 7). Penicillin susceptibility had no effect on the day to oral transition (p = 0.718). Total and departmental costs are depicted in Table 3. There was no significant difference on any cost level between patients infected with penicillin susceptible vs nonsusceptible S pneumoniae. The greatest percentage of total cost resources utilized were allocated to hospital bed costs (including both non-ICU and ICU beds) at 55.6%, followed by laboratory (9.9%) and pharmacy (9.8%) costs (Fig 1).

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Resource Utilization of Adults Admitted to a Large Urban Hospital With Community-Acquired Pneumonia Caused by Streptococcus pneumoniae: Results

Published in Pulmonary Function

Resource Utilization of Adults Admitted to a Large Urban Hospital With Community-Acquired Pneumonia Caused by Streptococcus pneumoniae: ResultsOf the 543 patients identified with S pneumoniae-positive blood and/or respiratory culture findings, 168 patients met inclusion/exclusion criteria. Patients were excluded from the analysis for the following reasons: 203 patients had HIV infection, 72 patients did not meet clinical criteria or did not have a positive chest radiographic finding, 65 patients were discharged from the emergency department or admitted to the hospital for < 2 days, and 35 patients were infected with another bacteria at baseline other than those allowed in the inclusion/exclusion criteria. cheap wellbutrin
Overall, patients were elderly (mean age, 63 years) and were equally divided among male and female gender (Table 1). Twenty-seven percent of patients were directly admitted to the ICU, and 42% had bacteremic pneumonia. The high severity of illness of this population was also apparent in the PSI score with 33% of patients in class IV and 23% in class V. Penicillin susceptibility was 74%; 11% were intermediate resistant, and 16% displayed high-level resistance. Crude mortality was 13% but was 21% among subjects within PSI classes IV and V. Ninety-five percent of patients who died were in PSI classes IV and V; one patient in PSI class III also died.

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Resource Utilization of Adults Admitted to a Large Urban Hospital With Community-Acquired Pneumonia Caused by Streptococcus pneumoniae: Statistics

Published in Pulmonary Function

Economic analyses were conducted from the hospital perspective. The primary analysis separated the cohort into two groups based on penicillin susceptibility (susceptible vs nonsusceptible). For all comparisons, the nonsusceptible group included both intermediate-resistant and resistant S pneumoniae. Continuous data were compared using a Student t test for normally distributed data or Mann-Whitney U test for nonnormally distributed data (eg, costs and length of stay). x2 or Fisher exact test were used to compare proportions between the two groups. For cost comparison between susceptible, intermediate, and resistant groups, data were analyzed by the Kruskal-Wallis rank-sum test.
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