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Healthcare Payment Systems
Published in Jennifer Doley, Mary J. Marian, Adult Malnutrition, 2023
If malnutrition diagnoses documented by RDNs are not also documented by physicians, they will not be coded and the hospital can lose significant revenue due to missed opportunities to accurately assign the MS-DRG and capture patients’ SOI and ROM. In 2015, a retrospective chart review was completed at a major academic medical center for 217 patients with community-acquired pneumonia (CAP) discharged over a one-year period.14 Of these patients, there was a 58% misdiagnosis rate for severe protein-calorie malnutrition (E43) and lost revenue of $29,813. Similarly, another retrospective chart review at the same institution showed that 39 of 456 patients discharged during April 2015 with chronic obstructive pulmonary disease, CAP, spinal fusion, or chemotherapy were malnourished.15 Of these patients, 19 were coded with malnutrition appropriately, whereas 20 patients were not, indicating malnutrition coding accuracy of only 50%. Of the 20 patients who were not coded for malnutrition when they should have been, nine would have made a payment difference if they had been coded appropriately, translating to $76,500 in missed revenue.
Respiratory
Published in Kristen Davies, Shadaba Ahmed, Core Conditions for Medical and Surgical Finals, 2020
Pneumonia describes any inflammatory condition affecting the alveoli of the lung. In the vast majority of cases this is secondary to a bacterial infection. It can be classified by whether the illness started in the community (community-acquired pneumonia [CAP]) or after 48 hours in the hospital (hospital-acquired pneumonia [HAP]).
Severe Community-Acquired Pneumonia in the Critical Care Unit
Published in Cheston B. Cunha, Burke A. Cunha, Infectious Diseases and Antimicrobial Stewardship in Critical Care Medicine, 2020
Community-acquired pneumonia occurs in normal or compromised hosts. The clinical approach is to determine the cause of severe CAP, which depends on assessing cardiopulmonary status and degree of splenic dysfunction and identifying the disorders associated with specific immune defects, e.g., β-lymphocyte (humoral immunity [HI]). Analysis of host defense defects by history is combined with the chest X-ray findings and degree of hypoxemia [1,8]. After non-infectious causes of severe CAP are ruled out, i.e., mimics of CAP, the physician should then consider the DDx of non-infectious disorders resembling CAP [8–10].
Delafloxacin as a treatment option for community-acquired pneumonia infection
Published in Expert Opinion on Pharmacotherapy, 2021
Cristiana M. Nascimento-Carvalho
Adulthood community-acquired pneumonia imposes a major burden on the health care system all over the world as it is responsible for high morbidity and mortality rates [1]. Bacterial pathogens are recognized to be frequent causative agents, which makes antibacterial treatment crucial for the good prognosis of these patients. There are several antimicrobial options available in daily practice. However, bacterial resistance is a problem to be faced. In vitro data showed that delafloxacin is active against a wide range of bacteria, including the majority of community-acquired pneumonia bacterial agents among adults. Besides that, results from phase 2 and phase 3 have demonstrated that delafloxacin use is safe. Nonetheless, the judicious use of such a broad-spectrum antibacterial drug is imperative once it comes to market to prevent the development of resistance [54]. In 2017, 22% of MRSA isolates, associated either with healthcare-related infections or community-associated infections, from seven hospitals in New York, were nonsusceptible to delafloxacin [55].
Prognosis of severe lower respiratory tract infected patients with virus detected: a retrospective observational study
Published in Infectious Diseases, 2021
Yuan Zhang, Qiuping Huang, Zhigang Zhou, Yun Xie, Xianchen Li, Wei Jin, Ruilan Wang
Community acquired lower respiratory tract infection (LRTI) is the most common reason for requiring mechanical ventilation (MV) support among cases admitted to an Intensive Care Unit (ICU). In the past, bacterial infection was considered to be the leading cause of community acquired pneumonia (CAP), and the Streptococcus Pneumoniae accounted nearly half of the culprit pathogen. However, since the outbreak of Influenza A (H1N1) in 2009, there was an increasing number of viral pneumonia cases admitted to ICU [1]. Studies on American adult or paediatric CAP patients who required hospitalization indicated that respiratory viral infection accounted for the largest proportion [2,3]. A prospective study on the aetiology of adult LRTI in a European primary hospital found that bacterial infection accounted for only one fifth of the total while viral infection accounted for nearly half [4].
Prognostic factors in elderly patients admitted to the intensive care unit with community-acquired pneumonia
Published in The Aging Male, 2020
Hakan Çelikhisar, Gülay Daşdemir Ilkhan, Çiğdem Arabaci
Despite recent advances in antimicrobial treatment, community acquired pneumonia (CAP) is one of the leading infectious cause of intensive care unit (ICU) admissions and adult mortality in developed countries [1,2]. Moreover, this common disease also incurs a significant economic burden [3]. Although there are some scores such as CURB-65 score including confusion, urea, respiratory rate, blood pressure, and age ≥ 65 years score and Pneumonia Severity Index, the data regarding the risk factors for mortality in patients admitted in ICU for CAP is conflicting [4]. In this study we aimed to determine the clinical, radiological and laboratory findings that may indicate poor prognosis in severe community acquired pneumonia requiring intensified care to reduce the risk of death. We believe that, considering these parameters in the follow-up and treatment of patients will decrease the morbidity and mortality rates in CAP.