Factors associated with pneumonia outcomes: a nationwide population-based study over the 1997-2008 period.

BACKGROUND: Pneumonia is the most common infectious cause of death worldwide. Over the last decade, patient characteristics and health care factors have changed. However, little information is available regarding systematically and simultaneously exploring effects of these changes on pneumonia outcomes.

OBJECTIVES: We used nationwide longitudinal population-based data to examine which patient characteristics and health care factors were associated with changes in 30-day mortality rates for pneumonia patients.

DESIGN: Trend analysis using multilevel techniques.

SETTING: General acute care hospitals throughout Taiwan.

PARTICIPANTS: A total of 788,011 pneumonia admissions.

MEASUREMENTS: Thirty-day mortality rates. Taiwan's National Health Insurance claims data from 1997 to 2008 were used to identify the effects of patient characteristics and health care factors on 30-day mortality rates.

RESULTS: Male, older, or severely ill patients, patients with more comorbidities, weekend admissions, larger reimbursement cuts and lower physician volume were associated with increased 30-day mortality rates. Moreover, there were interactions between patient age and trend on mortality.

CONCLUSIONS: Male, older or severely ill patients with pneumonia have higher 30-day mortality rates. However, mortality gaps between elderly and young patients narrowed over time; namely, the decline rate of mortality among elderly patients was faster than that among young patients. Pneumonia patients admitted on weekends also have higher mortality rates than those admitted on weekdays. The mortality of pneumonia patients rises under increased financial strain from cuts in reimbursement such as the Balanced Budget Act in the United States or global budgeting. Higher physician volume is associated with lower mortality rates.