Association of hospital spending with care patterns and mortality in patients hospitalized with community‐acquired pneumonia

Abstract

AbstractBackgroundPneumonia is a leading cause of mortality and intensive therapy is costly. However, it is unclear whether more spending is associated with better patient outcomes or how hospitals could decrease costs.ObjectivesThis study investigates the association between hospital spending and 14‐day inpatient mortality among community‐acquired pneumonia inpatients.MethodsThis retrospective cohort study focused on adult pneumonia patients discharged between July 2010 and June 2015 from 260 US hospitals in the Premier database. Hospitals were divided into four pneumonia cost‐of‐care quartiles and average cost was calculated for each hospital. Odds of 14‐day inpatient mortality and care practices were compared among high and low‐cost hospitals.ResultsThe study population comprised 534,038 patients with a mean age 69.5 (SD 16.3); 51.9% were female, 75% White, and 71.9% covered by Medicare. Hospitals were largely medium‐sized (40.4%), located in the South (49.2%), and in urban areas (82.3%). The fully adjusted population‐averaged cost was 14,486 US dollars (95% confidence interval [CI] 13,982–14,867). Hospital practices associated with cost included intensity of diagnostic work‐up +$14 (95% CI +12 to +18; p < .0001) and de‐escalation of antibiotic therapy, +$6836 (95% CI +2291 to +11,160; p = .004). There was no significant difference in odds of 14‐day inpatient mortality between hospitals in the highest and lowest cost quartiles.ConclusionsGreater spending at the hospital level was not associated with lower mortality. Lower diagnostic costs were associated with lower cost of care, suggesting that judicious use of diagnostic testing might reduce costs without worsening patient outcomes.