Among Medicare beneficiaries, ICU admission of patients hospitalized with pneumonia was linked to improved survival as well as no notable difference in hospital costs.

Thomas S. Valley, MD, of the University of Michigan, Ann Arbor, and colleagues examined the association between ICU admission and outcomes, 30-day mortality and costs, among elderly patients hospitalized for pneumonia. The study included Medicare beneficiaries (older than 64 years of age) admitted to 2,988 acute care hospitals in the United States with pneumonia from 2010 to 2012.

Among 1,112,394 Medicare beneficiaries with pneumonia, 328,404 (30%) were admitted to the ICU. Patients (n = 553,597) living closer than the median differential distance (less than 3.3 miles) to a hospital with high ICU admission were significantly more likely to be admitted to the ICU than patients living farther away (n = 558,797) (36 percent for patients living closer vs 23 percent for patients living farther).

For the 13 percent of patients whose ICU admission decision appeared to be discretionary (dependent only on distance), ICU admission was associated with a significantly lower adjusted 30-day mortality (14.8 percent for ICU admission vs 20.5 percent for general ward admission), yet there were no significant differences in Medicare spending or hospital costs for the hospitalization.

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