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American Journal of Medical Quality, Vol. 11, No. 4, 186-192 (1996)
DOI: 10.1177/0885713X9601100406

Secondary Diagnoses as Predictive Factors for Survival or Mortality in Medicare Patients with Acute Pneumonia

Steven R. White, M.D.

The Pritzker School of Medicine

Roger Hand, M.D.

University of Chicago, Chicago Illinois, The University of Illinois at Chicago College of Medicine, Chicago, Illinois

Linda Klemka-Walden, B.S.

The Crescent Counties Foundation for Medical Care, Lisle, Illinois USA

Dale Inczauskis, M.S.

The Crescent Counties Foundation for Medical Care, Lisle, Illinois USA

We wished to determine if a claims-based method for severity adjustment would predict mortality or survival in pneumonia based on age, gender, and secondary diag noses. We used a discriminant analysis model of severity of illness developed from Medicare Part A claims data. Our data base was taken from a hospitalized population age 65 years or older coded as DRG 89 (pneumonia with complications/comorbidities). There were 35,677 cases with a mortality = 11.2% in the derivation cohort from 1989 to 1990, and 19,915 cases with a mortality = 9.8% in the validation cohort from 1991. In the derivation cohort, 98% of patients predicted to live, lived, whereas 18% of patients predicted to die, died. Of the three vari ables, secondary diagnoses had greatest explanatory power. Receiver operating characteristic curves showed that the model performed best at 40% survival. Results were confirmed with the 1991 validation cohort. The model could be applied to hospitals with as few as 172 discharges. This simple, claims-based method can pre dict survival in pneumonia. It may be useful in selecting medical records for intensified review of medical quality.


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