Resource Utilization of Adults Admitted to a Large Urban Hospital With Community-Acquired Pneumonia Caused by Streptococcus pneumoniae: Data Collection
Patients were excluded if their total hospitalization was < 2 days, if they had impaired immune function (ie, AIDS, HIV, leukocyte count < 1,000/^L), known or suspected tuberculosis, known or suspected Pneumocystis ji-roveci, or concomitant pneumonia or other infection at baseline caused by viruses, fungi, or other bacteria except intracellular pathogens (Mycoplasma pneumoniae, Chlamydophila pneumoniae, Legionella pneumoniae), Haemophilus influenzae, or Moraxella catarrhalis. naturalbreastenhancementpill.com
Medical charts were reviewed for all identified patients, and data were collected using a standardized collection tool. Information documented included patient demographics; comorbid conditions (diabetes, COPD, neoplasm, congestive heart failure [CHF], cirrhosis, or other chronic liver disease); microbiology data including penicillin susceptibility and culture source; admission year; hospital length of stay; presence of ICU stay; pneumonia severity illness (PSI) score; antibiotic therapy (including route); daily maximum temperature and WBC count; and crude mortality at end of hospitalization.
Penicillin susceptibility was defined according to current Clinical and Laboratory Standards Institute guidelines as susceptible (penicillin minimum inhibitory concentration [MIC] < 0.06 |j,g/mL), intermediate resistant (MIC, 0.12 to 1.0 |j,g/mL), or resistant (MIC > 2.0 ^g/mL). Comorbid conditions were positive if they were present at baseline except for neoplasm, which was any cancer except basal or squamous cell cancer of the skin that was active at time of presentation or diagnosed within 1 year of presentation.
All resource utilization and economic data were derived from the patient’s detailed medical bill. Each bill was separated by the following pertinent charge departments: hospital bed charges (further divided by non-ICU bed or ICU bed), pharmacy, antibiotic specific charges, laboratory, radiology, respiratory care, rehabilitation, and other. At Hartford Hospital, the accounting system considers fixed indirect and direct costs (ie, nursing and physician services, housekeeping, electricity, administration) within the hospital bed charge, and the quantity of services utilized will be reflected in the bed charge (eg, ICU bed charge greater than non-ICU bed charge because of greater intensity of services). All charges were converted to costs using department specific cost-to-charge ratios and inflated to 2004 using the medical component of the consumer price index for all consumers in US cities (www.bls.gov/data/home.htm). Total costs equaled the sum of all department costs. Costs associated with specific services known not to be associated with the patient’s admission for CAP (eg, open-heart surgery) were excluded.