title: Hospital-reported data on the pneumonia quality measure "Time to First Antibiotic Dose" are not associated with inpatient mortality: results of a nationwide cross-sectional analysis.
abstract: OBJECTIVE
  Significant controversy exists regarding the Centers for Medicare & Medicaid Services (CMS) "time to first antibiotics dose" (TFAD) quality measure. The objective of this study was to determine whether hospital performance on the TFAD measure for patients admitted from the emergency department (ED) for pneumonia is associated with decreased mortality.
  
  
  METHODS
  This was a cross-sectional analysis of 95,704 adult ED admissions with a principal diagnosis of pneumonia from 530 hospitals in the 2007 Nationwide Inpatient Sample. The sample was merged with 2007 CMS Hospital Compare data, and hospitals were categorized into TFAD performance quartiles. Univariate association of TFAD performance with inpatient mortality was evaluated by chi-square test. A population-averaged logistic regression model was created with an exchangeable working correlation matrix of inpatient mortality adjusted for age, sex, comorbid conditions, weekend admission, payer status, income level, hospital size, hospital location, teaching status, and TFAD performance.
  
  
  RESULTS
  Patients had a mean age of 69.3 years. In the adjusted analysis, increasing age was associated with increased mortality with odds ratios (ORs) of >2.3. Unadjusted inpatient mortality was 4.1% (95% confidence interval [CI] = 3.9% to 4.2%). Median time to death was 5 days (25th-75th interquartile range = 2-11). Mean TFAD quality performance was 77.7% across all hospitals (95% CI = 77.6% to 77.8%). The risk-adjusted OR of mortality was 0.89 (95% CI = 0.77 to 1.02) in the highest performing TFAD quartile, compared to the lowest performing TFAD quartile. The second highest performing quartile OR was 0.94 (95% CI = 0.82 to 1.08), and third highest performing quartile was 0.91 (95% CI = 0.79 to 1.05).
  
  
  CONCLUSIONS
  In this nationwide heterogeneous 2007 sample, there was no association between the publicly reported TFAD quality measure performance and pneumonia inpatient mortality.
authors.affiliation: Department of Emergency Medicine (EQ, ESP, RKK, NC, KS, UP, MJP, DMC) and the Institute for Healthcare Studies and Division of General Internal Medicine, Northwestern University, Feinberg School of Medicine (ESP, RKK, JF), Chicago, IL, USA. e-quattromani@md.northwestern.edu
authors.forename: Erin
authors.initials: E
authors.lastname: Quattromani
authors.forename: Emilie S
authors.initials: ES
authors.lastname: Powell
authors.forename: Rahul K
authors.initials: RK
authors.lastname: Khare
authors.forename: Navneet
authors.initials: N
authors.lastname: Cheema
authors.forename: Kori
authors.initials: K
authors.lastname: Sauser
authors.forename: Usha
authors.initials: U
authors.lastname: Periyanayagam
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Pirotte
authors.forename: Joe
authors.initials: J
authors.lastname: Feinglass
authors.forename: D
authors.initials: D
authors.lastname: Mark Courtney
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D002423:Cause of Death; D015897:Comorbidity; D003430:Cross-Sectional Studies; D004636:Emergency Service, Hospital / Q000592:standards*; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D016015:Logistic Models; D008297:Male; D006278:Medicare; D008875:Middle Aged; D011014:Pneumonia / Q000188:drug therapy* / Q000401:mortality; D017064:Process Assessment, Health Care; D019984:Quality Indicators, Health Care / Q000706:statistics & numerical data; D013997:Time Factors; D014481:United States / Q000453:epidemiology; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents