title: Quality of care for elderly patients hospitalized for pneumonia in the United States, 2006 to 2010.
abstract: OBJECTIVE
  Nearly every US acute care hospital reports publicly on adherence to recommended processes of care for patients hospitalized with pneumonia. However, it remains uncertain how much performance of these process measures has improved over time or whether performance is associated with superior patient outcomes.
  
  
  OBJECTIVE
  To describe trends in processes of care, mortality, and readmission for elderly patients hospitalized for pneumonia and to assess the independent associations between processes and outcomes of care.
  
  
  METHODS
  Retrospective cohort study conducted from January 1, 2006, to December 31, 2010, at 4740 US acute care hospitals. The cohort included 1 818 979 cases of pneumonia in elderly (≥65 years), Medicare fee-for-service patients who were eligible for at least 1 of 7 pneumonia inpatient processes of care tracked by the Centers for Medicare & Medicaid Services (CMS).
  
  
  METHODS
  Annual performance rates for 7 pneumonia processes of care and an all-or-none composite of these measures; and 30-day, all-cause mortality and hospital readmission, adjusted for patient and hospital characteristics.
  
  
  RESULTS
  Adjusted annual performance rates for all 7 CMS processes of care (expressed in percentage points per year) increased significantly from 2006 to 2010, ranging from 1.02 for antibiotic initiation within 6 hours to 5.30 for influenza vaccination (P < .001). All 7 measures were performed in more than 92% of eligible cases in 2010. The all-or-none composite demonstrated the largest adjusted relative increase over time (6.87 percentage points per year; P < .001) and was achieved in 87.4% of cases in 2010. Adjusted annual mortality decreased by 0.09 percentage points per year (P < .001), driven primarily by decreasing mortality in the subgroup not treated in the intensive care unit (ICU) (-0.18 percentage points per year; P < .001). Adjusted annual readmission rates decreased significantly by 0.25 percentage points per year (P < .001). All 7 processes of care were independently associated with reduced 30-day mortality, and 5 were associated with reduced 30-day readmission.
  
  
  CONCLUSIONS
  Performance of processes of care for elderly patients hospitalized for pneumonia improved substantially from 2006 to 2010. Adjusted 30-day mortality declined slightly over time primarily owing to improved survival among non-ICU patients, and all individual processes of care were independently associated with reduced mortality.
authors.affiliation: Division of General Internal Medicine, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania.
authors.forename: Jonathan S
authors.initials: JS
authors.lastname: Lee
authors.affiliation: Oklahoma Foundation for Medical Quality, Oklahoma City.
authors.forename: Wato
authors.initials: W
authors.lastname: Nsa
authors.affiliation: Division of General Internal Medicine, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania3Veterans Affairs Pittsburgh Healthcare System, Center for Health Equity Research and Promotion, Pittsburgh, Pennsylvania.
authors.forename: Leslie R M
authors.initials: LR
authors.lastname: Hausmann
authors.affiliation: Department of Health Services, Policy and Practice, Brown University, Providence, Rhode Island.
authors.forename: Amal N
authors.initials: AN
authors.lastname: Trivedi
authors.affiliation: Colleges of Medicine and Public Health, Oklahoma University Health Sciences Center, Oklahoma City.
authors.forename: Dale W
authors.initials: DW
authors.lastname: Bratzler
authors.affiliation: Oklahoma Foundation for Medical Quality, Oklahoma City.
authors.forename: Dana
authors.initials: D
authors.lastname: Auden
authors.affiliation: Veterans Affairs Pittsburgh Healthcare System, Center for Health Equity Research and Promotion, Pittsburgh, Pennsylvania6Department of Biostatistics, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania.
authors.forename: Maria K
authors.initials: MK
authors.lastname: Mor
authors.affiliation: Centers for Medicare & Medicaid Services, Baltimore, Maryland.
authors.forename: Kristie
authors.initials: K
authors.lastname: Baus
authors.affiliation: Centers for Medicare & Medicaid Services, Baltimore, Maryland.
authors.forename: Fiona M
authors.initials: FM
authors.lastname: Larbi
authors.affiliation: Division of General Internal Medicine, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania3Veterans Affairs Pittsburgh Healthcare System, Center for Health Equity Research and Promotion, Pittsburgh, Pennsylvania.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Fine
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D014487:Centers for Medicare and Medicaid Services, U.S.; D005260:Female; D006760:Hospitalization; D006801:Humans; D007591:Joint Commission on Accreditation of Healthcare Organizations; D008297:Male; D010043:Outcome and Process Assessment, Health Care; D011014:Pneumonia / Q000401:mortality / Q000628:therapy*; D011787:Quality of Health Care / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D014481:United States / Q000453:epidemiology