Pneumonia Care Performance Detail

What this information tells us

Results

What one should know about the data

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What this information tells us

What’s important to know about pneumonia and oxygenation assessment

Results 

• In 2006, Joint Commission-accredited hospitals achieved national average performance of 99.6 percent in measuring blood oxygen level in pneumonia patients – an improvement of 0.3 percentage points from 2005, of 1 percentage point from 2004, of 2.4 percentage points from 2003, and of 4.6 percentage points from 2002.
• Performance rates among states ranged from 98.9 to 100 percent.
• Of all the measures covered in this report, hospitals showed the best performance on this particular treatment. This measure also showed the least variability, meaning it was provided more consistently at all Joint Commission accredited hospitals. 

 
What one should know about the data

• Some pneumonia patients had the oxygen in their bloodstream measured but were excluded from these data for one or more of the following reasons:
  • The patient was not diagnosed with pneumonia at the time of admission to the hospital.
  • The patient’s chest X-ray or CT scan was not positive for pneumonia anytime during the patient’s stay in the hospital or within 24 hours before the patient arrived at the hospital.
  • The patient was younger than 18 years of age.
  • The patient was transferred from another acute care or critical access hospital, including another emergency department.
  • The patient received comfort care only.
    

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What this information tells us

What’s important to know about pneumonia screening and vaccination

• It’s important to give pneumonia vaccine because of the increasing resistance of pneumonia bacteria to antibiotics. ²⁵

• Studies show that vaccination is up to 60 percent effective in preventing bacterial infection. ^{26, 27}

• National guidelines recommend that pneumococcal vaccine be given to all patients age 65 or older and younger patients who have medical conditions associated with increased risk for pneumonia. Revaccination is recommended after 5 to 7 years. ^{25, 28}

Results

• In 2006, Joint Commission-accredited hospitals achieved national average performance of 75.8 percent in providing pneumococcal screening and vaccinating pneumonia patients—an improvement of 12.9* percentage points from 2005, of 27.0 percentage points from 2004, of 38.2 percentage points from 2003, and of 45.6 percentage points from 2002.

• Performance rates among states ranged from 55.5 to 91.0 percent. There has been significant improvement over time.

 
What one should know about the data

• Some pneumonia patients received pneumococcal screening and vaccination but were excluded from these data for one or more of the following reasons:
  • The patient was not diagnosed with pneumonia at the time of admission to the hospital.
  • The patient’s chest X-ray or CT scan was not positive for pneumonia anytime during the patient’s stay in the hospital or within 24 hours before the patient arrived at the hospital.
  • The patient was younger than 65 years of age.
  • The patient was transferred to another general or federal hospital.
  • The patient was discharged to hospice.
  • The patient left the hospital against medical advice.
  • The patient received comfort care only.
  • The patient died.  

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What this information tells us

What’s important to know about pneumonia and blood cultures

Results 

• In 2006, Joint Commission-accredited hospitals achieved national average performance of 90.4 percent in taking a blood test of pneumonia patients in the ICU before giving them antibiotics.
• Performance rates among states ranged from 82.2 to 95.3 percent, showing wide variability across the nation.

What one should know about the data

• Prior to 2006, this measure was called “blood tests before giving antibiotics.” By 2006, the measure was divided into two measures to enable performance measurement in two distinct settings of care, the intensive care unit (ICU) and emergency department (ED).
• Some pneumonia patients were given a blood test in the intensive care unit (ICU) before being given antibiotics but were excluded from these data for one or more of the following reasons:
  • The patient did not receive antibiotics or have a blood culture.
  • The patient was not diagnosed with pneumonia at the time of admission to the hospital.
  • The patient’s chest X-ray or CT scan was not positive for pneumonia anytime during the patient’s stay in the hospital or within 24 hours before the patient arrived at the hospital.
  • The patient was younger than 18 years of age.
  • The patient was transferred from another acute care or critical access hospital, including another emergency department.
  • The patient received comfort care only.         
    

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What this information tells us

What’s important to know about pneumonia and blood cultures

Results 

• In 2006, Joint Commission-accredited hospitals achieved national average performance of 90.1 percent in taking a blood test of pneumonia patients in the ED before giving them antibiotics.
• Performance rates among states ranged from 82.2 to 94.9 percent, showing wide variability across the nation. 

What one should know about the data

• Prior to 2006, this measure was called “blood tests before giving antibiotics.” By 2006, the measure was divided into two measures to enable performance measurement in two distinct settings of care, the intensive care unit (ICU) and emergency department (ED).
• Some pneumonia patients were given a blood test in the emergency department (ED) before being given antibiotics but were excluded from these data for one or more of the following reasons:
  • The patient did not receive antibiotics or have a blood culture.
  • The patient was not diagnosed with pneumonia at the time of admission to the hospital.
  • The patient’s chest X-ray or CT scan was not positive for pneumonia anytime during the patient’s stay in the hospital or within 24 hours before the patient arrived at the hospital.
  • The patient was younger than 18 years of age.
  • The patient was transferred from another acute care or critical access hospital, including another emergency department.
  • The patient received comfort care only. 
    

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What this information tells us

These data report the percentage of pneumonia patients who were given advice or counseling about quitting smoking.

 

What’s important to know about pneumonia and smoking cessation advice

• More than 25 percent of adult American men and 20 percent of adult American women are smokers. ⁶
• Studies show that smokers are more likely to quit smoking if a doctor advises them to stop.⁷
• One year after quitting smoking, a person’s risk of heart disease decreases by 50 percent. ⁶
• National guidelines recommend smoking cessation counseling for pneumonia patients who smoke.⁸ 

Results 

• In 2006, Joint Commission-accredited hospitals achieved national average performance of 89.4 percent in advising pneumonia patients to quit smoking – an improvement of 9.3* percentage points from 2005, of 23.9 percentage points from 2004, of 39.2 percentage points from 2003, and of 52.2 percentage points from 2002.

• Performance rates among states ranged from 70.9 to 95.9 percent, showing wide variability across the nation.

• Smoking cessation advice is the only measure provided for heart attack, heart failure and pneumonia care. Performance in providing smoking cessation advice to pneumonia and heart failure patients improved at a faster rate than advice provided to heart attack patients. 

What one should know about the data

• Some pneumonia patients received smoking cessation advice but were excluded from these data for one or more of the following reasons:
  • The patient was not diagnosed with pneumonia at the time of their admission to the hospital.
  • The patient’s chest X-ray or CT scan was not positive for pneumonia anytime during the patient’s stay in the hospital or within 24 hours before the patient arrived at the hospital.
  • The patient was younger than 18 years of age.
  • The patient was transferred to another federal or general hospital.
  • The patient was discharged to hospice.
  • The patient left against medical advice.
  • The patient received comfort care only.
  • The patient died in the hospital.
    

* This number varies from that in the previous report due to later additional data submissions and/or corrections to previously submitted data. 

 

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What this information tells us

These data report the percentage of pneumonia patients who received an antibiotic within 4 hours of arriving at the hospital.

 

What’s important to know about pneumonia and antibiotics

Studies show that pneumonia patients have better survival rates if they receive antibiotics within 3 to 8 hours of arriving at the hospital. ^{28, 29, 30, 31}

 

Results

• In 2006, Joint Commission-accredited hospitals achieved a national average performance of 79.0 percent in providing antibiotics to pneumonia patients within 4 hours of arrival at the hospital—an improvement of 4.5 percentage points from 2005, the first full year this measure was tracked.
• Performance rates among states ranged from 69.3 to 88.8 percent. 

What one should know about the data

• By 2005, this measure changed from one where “time to antibiotic” was measured and recorded to one where “the number of patients receiving antibiotics within 4 hours of arrival” was measured and recorded.
• Some pneumonia patients received this treatment but were excluded from these data for one or more of the following reasons:
  • The patient received antibiotics within 24 hours prior to arriving at the hospital.
  • The patient did not receive antibiotics within 36 hours from the time of hospital arrival.
  • The patient was not diagnosed with pneumonia at the time of admission to the hospital.
  • The patient’s chest X-ray or CT scan was not positive for pneumonia anytime during the patient’s stay in the hospital or within 24 hours before the patient arrived at the hospital.
  • The patient was younger than 18 years of age.
  • The patient was transferred from another acute care or critical access hospital, including another emergency department.
  • The patient was involved in clinical trials.
  • The patient received comfort care only. 
     

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What this information tells us

These data report the percentage of pneumonia patients (those with a certain type of pneumonia called Community Acquired Pneumonia) in the intensive care unit (ICU) who started taking antibiotics within 24 hours of arriving at the hospital.

 

What’s important to know about Community Acquired Pneumonia and antibiotics

Studies show that pneumonia patients have better survival rates if they receive antibiotics within 3 to 8 hours of arriving at the hospital. ^{28, 29, 30, 31}

Results

• In 2006, Joint Commission-accredited hospitals achieved a national average performance of 59.8 percent in starting ICU patients with Community Acquired Pneumonia on antibiotics within 24 hours of arrival at the hospital—an improvement of 9.6* percentage points from 2005, the first full year this measure was tracked.
• Performance rates among states ranged from 47.4 to 74.6 percent, showing wide variability across the nation.

What one should know about the data

• Some pneumonia patients received this treatment but were excluded from these data for one or more of the following reasons:
  • The patient did not receive antibiotics while in the hospital or within 36 hours after arriving at the hospital.
  • The patient was not diagnosed with pneumonia at the time of admission to the hospital.
  • The patient’s chest X-ray or CT scan was not positive for pneumonia anytime during the patient’s stay in the hospital or within 24 hours before the patient arrived at the hospital.
  • The patient had a type of pneumonia called Health Care Associated Pneumonia.
  • The patient’s immune system was already susceptible to infection.
  • The patient was not in the ICU.
  • The patient was younger than 18 years of age.
  • The patient was transferred from another acute care or critical access hospital, including another emergency department.
  • The patient was involved in clinical trials.
  • The patient received comfort care only. 

 

* This number varies from that in the previous report due to later additional data submissions and/or corrections to previously submitted data.

 

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What this information tells us

These data report the percentage of pneumonia patients (those with a certain kind of pneumonia called Community Acquired Pneumonia) who were not in the intensive care unit (ICU) and who started taking antibiotics within 24 hours of arriving at the hospital.

 

What’s important to know about Community Acquired Pneumonia and antibiotics

Studies show that pneumonia patients have better survival rates if they receive antibiotics within 3 to 8 hours of arriving at the hospital. ^{28, 29, 30, 31}

 

Results

• In 2006, Joint Commission-accredited hospitals achieved a national average performance of 88.8 percent in starting patients with Community Acquired Pneumonia who were not in the ICU on antibiotics within 24 hours of arrival at the hospital—an improvement of 4.8* percentage points from 2005, the first full year this measure was tracked.

• Performance rates among states ranged from 83.7 to 93.3 percent.

What one should know about the data

• Some pneumonia patients received this treatment but were excluded from these data for one or more of the following reasons:
  • The patient did not receive antibiotics while in the hospital or within 36 hours after arriving at the hospital.
  • The patient was not diagnosed with pneumonia at the time of admission to the hospital.
  • The patient’s chest X-ray or CT scan was not positive for pneumonia anytime during the patient’s stay in the hospital or within 24 hours before the patient arrived at the hospital.
  • The patient had a type of pneumonia called Health Care Associated Pneumonia.
  • The patient’s immune system was already susceptible to infection.
  • The patient was in the ICU.
  • The patient was younger than 18 years of age.
  • The patient was transferred from another acute care or critical access hospital, including another emergency department.
  • The patient was involved in clinical trials.
  • The patient received comfort care only. 

* This number varies from that in the previous report due to later additional data submissions and/or corrections to previously submitted data. 

 

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See Glossary for definitions. 

 

What this information tells us

These graphs show the national performance rates of Joint Commission-accredited hospitals for three pneumonia care measures evaluated over the course of four consecutive years (2002-2006) and for three more measures evaluated over two years (2005-2006).

 

What’s important to know about pneumonia

• Approximately 5 million cases of pneumonia occur annually. ²⁰
• Pneumonia is the cause of nearly 55 million days of restricted activity, 31.5 million bed days, and 1.3 million hospitalizations each year. ²¹
• Inpatient treatment for pneumonia amounts to more than $7.5 billion annually. ²²

Results

• Joint Commission-accredited hospitals reported improvement during the course of the study for all of the pneumonia measures, with the most significant improvement in providing smoking cessation advice to pneumonia patients.
• The best rates of performance were for:
  • Providing smoking cessation advice improved from 37.2 percent in 2002, to 50.2 percent in 2003, to 65.5 percent in 2004, to 80.1* percent in 2005, to 89.4 percent in 2006.
  • Pneumococcal screening and vaccination improved from 30.2 percent in 2002, to 37.6 percent in 2003, to 48.8 percent in 2004, to 62.9* percent in 2005, to 75.8 percent in 2006.
  • Measuring oxygen in the bloodstream improved from 95.0 percent in 2002, to 97.2 percent in 2003, to 98.6 percent in 2004, to 99.3 percent in 2005, to 99.6 percent in 2006.
• While performance in providing smoking cessation advice and in providing pneumococcal screening and vaccination is improving, there is still room for further improvement. In 2006, 89.4 percent of hospitals nationwide were advising pneumonia patients to quit smoking compared to 80.1* percent in 2005. In 2006, 75.8 percent of hospitals nationwide were providing pneumococcal screening and treatment to pneumonia patients, up from 62.9* percent in 2005.  

What one should know about the data

• While improvement sometimes is less than 1 percentage point, these are statistically significant improvements because of the larger number of hospitals that reported these data during the time period covered in these graphs. 

 

* This number varies from that in the previous report due to later additional data submissions and/or corrections to previously submitted data.