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Author List:
Mortensen EM (South Texas Health Care System/Audie L. Murphy Division)
Restrepo MI (South Texas Health Care System/Audie L. Murphy Division)
Anzueto A (South Texas Health Care System/Audie L. Murphy Division)
Pugh J (South Texas Health Care System/Audie L. Murphy Division)
Objectives:
Each year over 40,000 veterans are hospitalized with community-acquired pneumonia (CAP) in the VA health care system. Numerous studies have examined factors associated with extended length of stay (LOS) in the private sector but there has been little research comparing VA and non-VA systems. The purpose of this study was to examine the LOS for patients hospitalized with CAP at a VA medical center as compared to a country-run medical center.
Methods:
The two medical centers were both tertiary teaching hospitals in San Antonio, Texas and staffed by the same faculty and medicine housestaff. Eligible patients were admitted with a diagnosis of CAP between 1/1/1999 and 12/31/2001, had a chest x-ray consistent with CAP, and had a primary or secondary ICD-9 diagnosis of pneumonia. Patients were excluded if they were “comfort measures only” or transferred from another acute care hospital. Severity of illness was quantified using the Pneumonia Severity Index (PSI).
Results:
Information was obtained on 787 patients with CAP. The median age was 60 years, 79% were male, and 20% were initially admitted to the ICU. At presentation 52% of subjects were low risk, 34% were moderate risk, and 14% were high risk. Mortality was 13% at 90-days. There were significant differences in the LOS for low risk patients with the VA hospital having a LOS of 8.6 days versus 6.4 days for the county hospital (p=0.02). There were no significant differences in LOS for moderate or high-risk patients. In the linear regression analysis hospitalization at the VA medical center was associated with increased LOS after adjusting for other potential confounders including severity of illness processes of care, and use of guideline-concordant antibiotics.
Implications:
There are significant differences in LOS for patients hospitalized with CAP at a VA medical center compared to a county-run hospital in the same community.
Impacts:
Further study is needed to evaluate the quality of care for CAP throughout the entire VA health care system and assess the potential for reducing LOS for veterans with CAP.
