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Community-Acquired Pneumonia: Can It Be Defined with Claims Data?

Section of General Internal Medicine, Pittsburgh VA Medical Center, Division of General Internal Medicine, Department of Medicine

Michael J. Fine, M.D., M.Sc.

Division of General Internal Medicine, Department of Medicine

Dorothy Z. Joyce, M.A.

Pittsburgh Research Institute, Pittsburgh, Pennsylvania

Judith R. Lave, Ph.D.

Graduate School of Public Health, University of Pittsburgh

Wanda W. Young, Sc.D.

Pittsburgh Research Institute, Pittsburgh, Pennsylvania

Linda J. Hough, M.P.H.

Division of General Internal Medicine, Department of Medicine

Wishwa N. Kapoor, M.D., M.P.H.

Division of General Internal Medicine, Department of Medicine

The use of administrative data to study pneumonia is limited because International Classification of Diseases, 9th revision, Clinical Modification (ICD9-CM) diagnosis codes do not specify whether pneumonia is community-ac quired (CAP), a key clinical distinction. We classified 212 patients discharged with a diagnosis code for pneumonia as to whether or not they had CAP, using three adminis trative data-based systems (Diagnosis Related Groups (DRGs) alone, principal diagnosis alone, and a complex al gorithm). We examined agreement with classification by clinician chart review. We also compared the length of stay (LOS) and mortality among the CAP populations identi fied with different methods. Agreement between the clin ical review and the three administrative data methods ranged from 86 to 80%. Classification by DRG performed least well. Populations defined by claims data had similar mortality but shorter mean LOS (9.70, 9.40, and 7.91 days for the algorithm, principal diagnosis and DRG methods, respectively) than the clinically defined population (10.85 days). We conclude that studies of CAP using populations identified by claims may underestimate LOS.

American Journal of Medical Quality, Vol. 12, No. 4, 187-193 (1997)
DOI: 10.1177/0885713X9701200404


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