Presented at the Society for Academic Emergency Medicine annual meeting, Phoenix, AZ, June 2010.
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
Article first published online: 5 MAY 2011
© 2011 by the Society for Academic Emergency Medicine
Academic Emergency Medicine
Volume 18, Issue 5, pages 496–503, May 2011
How to Cite
Quattromani, E., Powell, E. S., Khare, R. K., Cheema, N., Sauser, K., Periyanayagam, U., Pirotte, M. J., Feinglass, J. and Mark Courtney, D. (2011), 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. Academic Emergency Medicine, 18: 496–503. doi: 10.1111/j.1553-2712.2011.01053.x
Dr. Powell and Dr. Khare are supported by a National Research Service Award postdoctoral fellowship grant through the Institute for Healthcare Studies at Northwestern University under institutional awards from AHRQ (T-32 HS 000078 and F-32 HS 17876-01). Dr. Courtney was supported by grant 5K23HL077404-04 from the National Heart, Lung, and Blood Institute.
The authors have no relevant financial information or potential conflicts of interest to disclose.
Supervising Editor: Christopher R. Carpenter, MD.
- Issue published online: 13 MAY 2011
- Article first published online: 5 MAY 2011
- Received September 7, 2010; revisions received October 21 and November 14, 2010; accepted November 19, 2010.
ACADEMIC EMERGENCY MEDICINE 2011; 18:496–503 © 2011 by the Society for Academic Emergency Medicine
Objectives: 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.