About the National Data
Baseline: 713.9 hospital admissions for pneumonia per 100,000 adults aged 65 years and over occurred in 2016
Target: 642.5 per 100,000
Based on ICD-10 codes: J13 (Bronchopneumonia due to S. pneumoniae), J14 (Bronchopneumonia due to H. influenzae), J15211 (Pneumonia due to Methicillin susceptible Staphylococcus aureus), J15212 (Pneumonia due to Methicillin susceptible Staphylococcus aureus), J153 (Pneumonia due to streptococcus, group B), J154 (Pneumonia due to other streptococci), J157 (Pneumonia due to Mycoplasma pneumoniae), J159 (Unspecified bacterial pneumonia), J160 (Chlamydial pneumonia), J168 (Pneumonia due to other specified infectious organisms), J180 (Bronchopneumonia, unspecified organism), J181 (Lobar pneumonia, unspecified organism), J188 (Other pneumonia, unspecified organism), J189 (Pneumonia, unspecified organism)
Exclusions from the numerator include transfers from another hospital, from a skilled nursing facility or intermediate care facility, transfer from other healthcare facilities; any-listed ICD-10-CM diagnosis codes for sickle cell anemia or HB-S disease; any-listed ICD-10-CM diagnosis codes or any-listed ICD-10-PCS procedure codes for immunocompromised state; and missing gender, age, quarter, year, and principal diagnosis.
The indicator is designed to capture community acquired bacterial pneumoniae that progress and result in hospitalization. With access to high quality care, early intervention and appropriate pharmaceutical treatments this condition can often be managed on an outpatient basis. The numerator includes common specified bacterial organisms, including pneumococcal, h. influenza, streptococcus, mycoplasma, chlamydia and other specified organisms. The numerator also includes unspecified organisms, since often cultures are not obtained or organisms are not identified for suspected bacterial pneumonia. The numerator excludes transfers from skilled nursing facilities which are more likely to represent facility-related infection control and from other acute care hospitals to avoid double counting encounters. Pneumonias in special populations with immunocompromised are also excluded since infections in these populations may be more likely to progress or require hospitalization despite access to high quality care. The population denominator is estimated using the US Census Data. Using a population denominator assumes a population health perspective. In the case of bacterial pneumonia, the choice of denominator assumes that all older individuals are at risk for developing bacterial pneumonia, and that access to quality care can minimize the likelihood of bacterial pneumonia progressing to severity or complications that would require hospitalization.