Pneumonia in the Elderly Hospitalized in the VA Health Care System

Introduction— Pneumonia is a major cause of hospital admissions and death worldwide, and the Veterans Health Administration (VA) is the largest integrated healthcare organization in the United States. Our aim was to examine trends in admissions for pneumonia in the VA system and compare characteristics and outcomes. Methods— Data was collected for fiscal years (FY) 2002 through 2007 on patients ≥ 65 years of age hospitalized with pneumonia in the VA health care system. We examined hospitalization rates, mortality, length of stay, intensive care unit admission, and mechanical ventilation. Results— The case rate of hospital admissions for pneumonia increased slightly during the period of study. However, patients including those requiring management in the ICU, had decreased lengths of stay, as well as decreased 30- and 90-day mortality. The proportion of patients admitted to the ICU remained relatively constant, but fewer received mechanical ventilation with a substantial increase in non-invasive ventilation. Conclusion— Hospitalization rates for pneumonia in the VA have increased since 2002. Concomitantly, once admitted these patients have had substantially decreased length of stay and mortality. While ICU admissions have remained steady, there has been a dramatic shift in mechanical ventilation practice towards a non-invasive approach. In the VA pneumonia-related admissions are being managed more effectively even as they are increasing in prevalence.