Table 1.
Cohort Selection of Patients Accounting for COPD and Pneumonia as Primary Discharge Diagnosis and 30-Day Mortality Rates by HRRP Periods from January 2013 to November 2017 in the United States
| HRRP Periods (Dates) | Announcement (January 2013–August 2014) | Implementation |
||
|---|---|---|---|---|
| October 2014–April 2016 | May 2016–November 2017 | |||
| A | Published cohort* | |||
| Index admissions, n | 647,815 | 631,118 | 685,027 | |
| Unique patients, n | 510,344 | 502,149 | 543,445 | |
| 30-d mortality rate, % (±SD) | 6.71 (0.8) | 6.81 (0.9) | 7.3 (1.1) | |
| A.1 | Published cohort without pneumonia† | |||
| Index admissions, n | 510,131 | 515,676 | 509,681 | |
| Unique patients, n | 412,508 | 418,976 | 411,739 | |
| 30-d mortality rate, % (±SD) | 6.03 (0.6) | 6.39 (0.9) | 7.00 (0.9) | |
| B | COPD and/or pneumonia as primary discharge diagnosis cohort‡ | |||
| Index admissions, n | 385,431 | 383,873 | 367,363 | |
| Unique patients, n | 344,120 | 344,713 | 329,175 | |
| 30-d mortality rate, % (±SD) | 8.77 (1.1) | 9.13 (1.1) | 9.89 (1.3) | |
| B.1 | Pneumonia primary discharge diagnosis cohort§ | |||
| Index admissions, n | 276,229 | 285,765 | 186,391 | |
| Unique patients, n | 254,798 | 263,671 | 175,106 | |
| 30-d mortality rate, % (±SD) | 9.65 (1.1) | 9.92 (1.05) | 11.78 (1.3) | |
| B.2 | COPD primary discharge diagnosis cohort‖ | |||
| Index admissions, n | 109,202 | 98,108 | 180,972 | |
| Unique patients, n | 102,633 | 93,089 | 168,520 | |
| 30-d mortality rate, % (±SD) | 6.06 (0.7) | 6.26 (0.9) | 7.59 (1.1) | |
Definition of abbreviations: CMS = Centers for Medicare and Medicaid Services; COPD = chronic obstructive pulmonary disease; HRRP = Hospital Readmissions Reduction Program; ICD = International Classification of Diseases; MEDPAR = Medicare Provider Analysis and Review.
Pneumonia ICD-9 codes = 4803, 4808, 4809, 481, 4820, 4821, 4822, 48230, 48231, 48232, 48239, 48240, 48241, 48249, 48281, 48282, 48283, 48284, 48289, 4829, 4830, 4831, 4838, 485, 486, and 4870. Pneumonia ICD-10 codes = A481, J1000, J1001, J1008, J1100, J1108, J120, J121, J122, J123, J1281, J1289, J129, J13, J14, J150, J151, J1520, J15211, J15212, J1529, J153, J154, J155, J156, J157, J158, J159, J160, J168, J180, J181, J188, J189, and J690. COPD ICD-9 codes = 49121, 49122, 4918, 4919, 4928, 49320, 49321, 49322, and 496. COPD ICD-10 codes = J418, J42, J430, J431, J432, J438, J439, J440, J441, and J449. COPD ICD-10 codes used to exclude pneumonia = J44.0 or J44.1 with secondary ICD-10 code for pneumonia. COPD ICD-10 codes for cohort selection = J41.8, J42, J43.0, J43.1, J43.2, J43.8, J43.9, J44.0, J44.1, and J44.9.
A. Published cohort. The cohort we present in our published paper (1). Please refer to Methods section of published main manuscript. Our data source, 100% Medicare beneficiary study files, only include inpatient claims (MEDPAR) and not Medicare Part B claims. Thus, unlike algorithms in CMS condition-specific measures updates and specifications report, we only require patients to have Part A continuous enrollment in the past 12 months before admission. We do not have a hospice claims file. Therefore, we could not strictly follow algorithms in CMS condition-specific measures updates and specifications report to exclude patients with hospice stay in 12 months before admission. Instead, we excluded direct transfers from hospice.
A.1 Published cohort without pneumonia. This is a subset of our published cohort A. Before October 2015, we exclude COPD index admissions with a secondary diagnosis of pneumonia (ICD-9). After October 2015, we exclude COPD index admissions with a primary diagnosis of J44.0 or J44.1 (with secondary ICD-10 code for pneumonia).
B. COPD and/or pneumonia as primary discharge diagnosis cohort. This includes index admissions with COPD (ICD-9 and ICD-10) in primary discharge diagnosis and pneumonia (ICD-9 and ICD-10) in secondary diagnosis or pneumonia in primary discharge diagnosis and COPD in secondary diagnosis.
B.1 Pneumonia Primary Discharge Diagnosis cohort: This is a subset of cohort B, with index admissions with pneumonia (ICD-9 and ICD-10) as the primary discharge diagnosis.
B.2 COPD Primary Discharge Diagnosis cohort: This is a subset of cohort B, with index admissions with COPD (ICD-9 and ICD-10) as the primary discharge diagnosis.