(HealthDay News) — Risk-standardized hospital mortality rates are higher with a broader versus a narrower definition of pneumonia, according to a study published in the March 18 issue of the Annals of Internal Medicine.

Michael B. Rothberg, MD, MPH, from the Cleveland Clinic, and colleagues conducted a cross-sectional study of 329 U.S. hospitals to assess the effect of the definition of pneumonia on hospital mortality rates. Patients included adults hospitalized for pneumonia (as a principal diagnosis or as a secondary diagnosis together with sepsis or respiratory failure as the principal diagnosis).

The researchers found that the risk-standardized mortality rate was significantly better than the mean for 4.3% of hospitals, and significantly worse than the mean for 6.4% of hospitals, when pneumonia was limited to patients with a principal diagnosis. Use of a broader definition to include patients with a principal diagnosis of sepsis or respiratory failure correlated with 11.9% of hospitals having a risk-standardized mortality rate better than the mean, and 22.8% having a rate worse than the mean; the outlier status changed for 28.3% of hospitals. For hospitals in the highest quintile of proportion of patients coded with a principal diagnosis of sepsis or respiratory failure, outlier status improved and worsened in 7.6 and 40.9%, respectively, under the broader definition. Twenty percent improved and none worsened among those hospitals in the lowest quintile.

“Variation in use of the principal diagnosis of sepsis or respiratory failure may bias efforts to compare hospital performance regarding outcomes of pneumonia,” the authors write.

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