A significant dip in costly and dangerous pneumonia hospitalizations and inpatient deaths from 2003 to 2009 may have been a result, at least in part, of changes in diagnostic coding rather than advances in healthcare quality. That's according to a study published in the April 4 issue of the Journal of the American Medical Association.
Coding changes may have shifted pneumonia figures: study
Using data from the Nationwide Inpatient Sample, researchers found that during the six-year period, the hospitalization rate of patients with a principal diagnosis of pneumonia fell by more than 27%, from 5.5 per 1,000 to 4 per 1,000. But during that same period, hospitalization rates increased significantly for patients with a primary diagnosis of sepsis and a secondary diagnosis of pneumonia, rising 177.6%, from 0.4 to 1.1 per 1,000.
Respiratory failure was another primary diagnosis that was also often paired with a secondary diagnosis of pneumonia, the authors said.
When all three diagnosis groups—sepsis, respiratory failure and pneumonia—were combined, inpatient mortality showed almost no change and the hospitalization rate from pneumonia decreased only 12.5%.
“These findings have important implications,” the authors wrote. “They suggest that attempts to measure the outcomes of patients with pneumonia by studying only those who receive a principal diagnosis of pneumonia will be biased toward increasingly less severe cases. This is especially problematic in the context of longitudinal studies that are subject to the effects of temporal trends in coding practice.”
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