Thursday, July 17, 2008

Questions on Defining Nosocomial Pneumonia

In response to the question on how to identify Nosocomial Pneumonia patients, there were different ways suggested to determine or validate on which some questions below

1. Patricia suggested “ Examine the DRG code for the patient-is it pneumonia or something else? Is pneumonia primary or secondary? If the DRG is for something else, the pneumonia is nosocomial.”

a. Is DRG code identified by the variable “RXNAME” (If am right, “RXNDC” is the
corresponding code for each RXNAME) in the medication file? If so, how do we
identify from the name which is for Pneumonia versus not?

2. There are 384 patients with one or more of the diagnosis suggesting Pneumonia of which 257 patients have SPECCOND = 1 (meaning Pneumonia is due to the hospital stay) and remaining 124 patients have missing SPECCOND. Does this mean these 257 patients are nosocomial Pneumonia patients and the rest are not?


Nick said...

1. Sorry again for the confusion - DRG is not recorded in this dataset, and posted responses relating to DRG should instead be interpreted as relating to ICD9 codes.

Since you bring up the prescription variables, though...

RXNAME: what the doctor wrote down.
RXNDC: the code for the specific prescription - medication, strength, brand. So, for example, Tylenol and Extra Strength Tylenol would have different codes.
RXHHNAME: self-reported (mostly over-the-counter) medications.

2. I think you've got the logic of SPECCOND turned around. It does not mean "pneumonia is due to the hospital stay," but rather, "the hospital stay is due to pneumonia." So in fact, a primary diagnosis of pneumonia and SPECCOND = 1 would be a clear indication that the patient entered the hospital with the condition.

Sri said...

A small clarification Nick...on the DRG code, the data dictionary says RXNDC is the National drug code. Isn't it the code that we are interested in provided we are able to identify which code corresponds to the drug for Pneumonia

Nick said...

You can use the RXNDC and correlate values with pneumonia diagnoses if you wish. My guess is that it would be easier to work the other way - do some research to find what drugs are actually used to treat pneumonia and search the actual drug name field RXNAME for these.

I'm not sure that there's any connection between RXNDC and DRG.