EVALUATION OF COMMUNITY ACQUIRED PNEUMONIA TREATMENT OUTCOMES AND COST OF ILLNESS AND DEVELOPMENT OF MORTALITY MODEL
Loading...
Date
2011-02
Authors
ALI AL-WORAFI, YASER MOHAMMED
Journal Title
Journal ISSN
Volume Title
Publisher
Abstract
Community acquired pneumonia (CAP) is a major cause of morbidity and mortality
worldwide including Malaysia. Identification of the differences in the outcome and
ost between a university hospital and a general hospital (GH) could lead to the
levelopment of pneumonia interventions and guide the health team to accurately
perfonn and administrate health care services effectively. The development and
validation of the pneumonia mortality model, which is easily accessible at the time of
admission can, identify patients who are at risks, and treat them appropriately.
Treatment of CAP is postly and the cost is related to the length of hospital stay
(LOS).Therefore, identification of the risk factors of increase the LOS is lead to
decrease the cost of CAP treatment. Therefore, this study aims firstly to compare the
treatment outcome and cost between a university hospital and a general hospital;
secondly, to develop pneumonia mortality model in Hospital Pulau Pinang (HPP)
and validation the model in Hospital Universiti 8ains Malaysia(HUSM); thirdly, to
identify the risk factors of increase the LOS. A retrospective observational study was
conducted among the adult patients with CAP who admitted to the Penang General
HPP and to the HUSM from 1st January 2007 to 31 st December 2008. Generally,
there is no significant difference between the outcome between the HUSM and HPP.
However, there is a significant difference between the cost between the HUSM and
HPP. The findings show that the HPP provided a similar treatment outcome at lower
CAP treatinent cost in comparison to HUSM. The pneumonia mortality model
composed of the following independent variables: confusion, respiratory rate> 30
xxviii
Ilthslmin, systolic blood pressure < 90 mmHg, random blood glucose> 13 mmolll,
chanica! ventilation, leu admission, concomitant disease more than or equal 3,
b < 8 gldl, urea> 11 mmo1ll, albumin < 30 gldl. The model sensitivity is 69.6 %,
ecificity is 98.0 %, Positive Predictive Value (pPV) is 83.6 %, Negative Predictive
due (NPV) is 95.8 % and area under the curve (AUC) is 0.839. There were the
Howing independent risk factors that significantly increase the length of hospital
ay; presences of the complications, elderly, presence of the concomitant diseases
ssociated with pneumonia, delay administration of antibiotics more than 8 hours and
tart the treatment with single antibiotic. It was concluded that the HPP provided a
imilar treatment outcome at lower CAP treatment cost in comparison to HUSM. The
validated model composed of easily accessible variables at the time of admission can,
identify patients who are at risks, and treat them appropriately.
Description
Keywords
ACQIDRED PNEUMONIA