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APPENDIXFigure 1.A. Patient Selection Flow Chart Table A.1. Diagnosis and Procedure Codes Used to Define Bacteremia and Respiratory Complications during Hospitalizations for Community-Acquired PneumoniaTable A2. Sensitivity Analyses of Length of Stay and Inpatient Death in Elderly Veterans Hospitalized for Community-Acquired Pneumonia in Fiscal Year 2003Table A.3. Sensitivity Analyses of Bacteremia and Respiratory Complications in Elderly Veterans Hospitalized for Community-Acquired Pneumonia in Fiscal Year 2003Table A.4. Sensitivity Analyses of Flu Season in Elderly Veterans Hospitalized for Community-Acquired Pneumonia in Fiscal Year 2003Table A.5. Sensitivity Analyses of Time since Last PV in Elderly Veterans Hospitalized for Community-Acquired Pneumonia in Fiscal Year 2003*APPENDIXFigure A.1: Patient Selection Flow ChartTable A.1: Diagnosis and Procedure Codes Used to Define Bacteremia and Respiratory Complications during Hospitalizations for Community-Acquired PneumoniaBacteremia and Respiratory ComplicationsICD-9 Diagnosis/Procedure CodesBacteremia 038.0x, 038.2x, 041.0x, 041.2x, 320.1x, 790.7xSepticemia 038.1x, 038.3x, 038.4x, 038.8x,038.9x, 020.2xAcute respiratory failure, distress or insufficiency518.81, 518.82, 786.09, 799.1xAtelectasis518.0xAcute bronchitis466.0xEmphysema without mention of fistula 510.9xSystemic inflammatory response syndrome (SIRS) 995.90-995.92Aspiration787.2x, 507.0xMechanical Ventilation96.70, 93.90, 93.91Table A2. Sensitivity Analyses of Length of Stay and Inpatient Death in Elderly Veterans Hospitalized for Community-Acquired Pneumonia in Fiscal Year 2003?Length of Stay (Days)Inpatient Death?IRR95% CIP-valueOR95% CIP-valueSA 1: Including admissions from nursing home or other inpatient facilities (n=7296)?PV in previous 5 Years1.020.97-1.070.55031.060.84-1.350.6102FV last year0.970.93-1.020.23850.830.66-1.060.1332Both0.910.87-0.960.00020.780.61-1.000.0472NeitherRef??Ref??SA 2: Excluding zero nights admission (n=6678)?PV in previous 5 Years1.030.97-1.080.33471.120.85-1.470.4224FV last year 0.97 0.92-1.020.21150.860.65-1.120.2555Both0.900.86-0.95<0.00010.860.65-1.130.2811NeitherRef??Ref??SA 3: Varying the number of VA outpatient visits each year in previous 5 years required for patient selection ?>=1 OP visit each year (main analysis, n=6723)?>=2 OP visit each year (n=6400)?PV in previous 5 Years1.030.98-1.090.28181.130.86-1.480.3938FV last year0.980.93-1.030.48190.880.67-1.160.3566Both0.910.87-0.960.00050.880.66-1.150.3450NeitherRefRef?>=3 OP visit each year (n=6013)?PV in previous 5 Years1.030.98-1.090.25001.150.87-1.540.3337FV last year0.980.93-1.040.54500.900.68-1.190.4498Both0.910.86-0.960.00100.900.68-1.200.4657NeitherRefRef?>=4 OP visit each year (n=5607)?PV in previous 5 Years1.050.99-1.110.11611.130.83-1.520.4381FV last year0.990.94-1.050.73020.850.63-1.140.2758Both0.920.87-0.970.00350.960.71-1.290.7739NeitherRefRef?>=5 OP visit each year (n=5162)?PV in previous 5 Years1.060.99-1.120.08491.060.77-1.470.7049FV last year0.980.93-1.040.50610.820.60-1.120.2199Both0.920.87-0.970.00360.960.70-1.300.7724NeitherRef??Ref??SA 4: Pneumonia Severity Score (n=3689): SA4.1. Adjusted for specific abnormal lab values (Hematocrit<30%, Sodium<130 mEg/L, Blood Urea Nitrogen>30mg/dL, Glucose≥250 mg/dL)?PV in previous 5 Years1.020.95-1.090.61101.661.17-2.350.0047FV last year0.920.86-0.980.01301.050.73-1.500.8095Both0.920.86-0.980.01001.090.75-1.590.6493NeitherRefRef?SA4.2. Adjusted for the abbreviated pneumonia severity score PV in previous 5 Years1.030.96-1.100.42211.641.16-2.320.0055FV last year0.920.86-0.980.01531.030.72-1.480.8613Both0.920.86-0.980.01181.120.77-1.620.5567NeitherRef??Ref??IRR: Incidence Rate Ratio; OR: Odds Ratio; PV: Pneumococcal Vaccine; FV: Influenza VaccineAll analyses have adjusted for patient's age, gender, race, marital status, comorbidity index score, non-MH outpatient visits and CAP hospitalization in the previous year, development of bacteremia, and respiratory complications, and any acute respiratory conditions experienced in the previous 30 days. Table A.3. Sensitivity Analyses of Bacteremia and Respiratory Complications in Elderly Veterans Hospitalized for Community-Acquired Pneumonia in Fiscal Year 2003?Bacteremia Respiratory Complication ?OR95% CIP-valueOR95% CIP-valueSA 1: Including admissions from nursing home or other inpatient facilities (n=7296)?PV in previous 5 Years0.710.47-1.060.09501.200.99-1.450.0572FV last year0.950.67-1.360.79450.910.75-1.100.3308Both0.750.51-1.100.14330.830.68-1.000.0552NeitherRef??Ref??SA 2: Excluding zero nights admission (n=6678)????PV in previous 5 Years0.670.44-1.040.07211.241.01-1.520.0372FV last year0.990.69-1.430.96300.890.73-1.090.2524Both0.720.48-1.070.10640.860.70-1.050.1459Neitherref??ref??SA 3: Varying the number of VA outpatient visits each year in previous 5 years required for patient selection ?>=1 OP visit each year (main analysis, n=6723, see Table 2)?>=2 OP visit each year (n=6400)?PV in previous 5 Years0.610.39-0.970.03681.190.96-1.460.1091FV last year1.020.71-1.480.90770.880.72-1.080.2202Both0.710.47-1.080.10560.860.69-1.050.1428NeitherRefRef?>=3 OP visit each year (n=6013)?PV in previous 5 Years0.620.39-0.990.04501.150.92-1.430.2119FV last year0.930.64-1.370.72860.920.74-1.130.4241Both0.690.45-1.050.08330.880.71-1.090.2471NeitherRefRef?>=4 OP visit each year (n=5607)?PV in previous 5 Years0.650.40-1.050.07791.040.88-1.390.3989FV last year0.920.61-1.380.67960.850.68-1.060.1533Both0.670.43-1.040.07630.850.68-1.060.1504NeitherRefRef?>=5 OP visit each year (n=5162)?PV in previous 5 Years0.640.39-1.060.08271.140.89-1.450.2985FV last year0.860.56-1.310.47630.890.70-1.120.3263Both0.690.43=1.080.10650.870.69-1.100.2523NeitherRef??Ref??SA 4: Pneumonia Severity Score (n=3689)?Adjusted for specific abnormal lab values (Hematocrit<30%, Sodium<130 mEg/L, Blood Urea Nitrogen>30mg/dL, Glucose≥250 mg/dL)?PV in previous 5 Years0.50.27-0.890.01971.391.07-1.820.0135FV last year0.780.48-1.260.30310.990.76-1.290.9453Both0.750.45-1.250.27380.820.61-1.080.1588NeitherRefRef?Adjusted for the abbreviated pneumonia severity score ?PV in previous 5 Years0.50.27-0.880.01781.391.07-1.800.0146FV last year0.770.48-1.240.28460.980.76-1.280.901Both0.720.43-1.190.20240.800.60-1.060.1213NeitherRef??Ref??OR: Odds Ratio; PV: Pneumococcal Vaccine; FV: Influenza VaccineAll analyses have adjusted for patient's age, gender, race, marital status, comorbidity index score, non-MH outpatient visits and CAP hospitalization in the previous year, and any acute respiratory conditions experienced in the previous 30 days. Table A.4. Sensitivity Analyses of Flu Season in Elderly Veterans Hospitalized for Community-Acquired Pneumonia in Fiscal Year 2003* ?Recode Those FV Vaccinated during the Past Flu Season as Unvaccinated (n=6723)Excluding Admissions Occurred During Non-Flu Season (n=5329)Length of StayLength of Stay?Vaccination StatusIRR95% CIP-valueIRR95% CIP-value PV in previous 5 Years1.010.96-1.060.72321.030.97-1.090.3172 FV last year0.990.90-1.010.59200.950.90-1.010.0910 Both0.920.88-0.970.00160.890.84-0.94<0.0001 NeitherRef??Ref??Inpatient DeathInpatient Death?Vaccination StatusOR95% CIP-valueOR95% CIP-value PV in previous 5 Years1.080.81-1.430.61511.080.80-1.450.6089 FV last year0.990.74-1.330.95400.980.73-1.320.8947 Both1.010.75-1.370.92881.010.75-1.350.9713 NeitherRef??Ref??BacteremiaBacteremia?Vaccination StatusOR95% CI?OR95% CIP-value PV in previous 5 Years0.680.45-1.030.07080.720.45-1.160.1812 FV last year1.030.71-1.480.87961.010.67-1.530.9564 Both0.730.49-1.100.13640.760.48-1.180.2199 NeitherRef??Ref??Respiratory ComplicationsRespiratory Complications?Vaccination StatusOR95% CI?OR95% CIP-value PV in previous 5 Years1.221.00-1.480.04691.411.13-1.760.0025 FV last year0.920.75-1.130.44040.960.76-1.200.7041 Both0.880.71-1.080.22150.880.70-1.110.2977 NeitherRef??Ref??IRR: Incident Rate Ratio; OR: Odds Ratio; PV: Pneumococcal Vaccine; FV: Influenza Vaccine* A flu season was defined as from September 1 to May 31 of the following year.All analyses have adjusted for patient's age, gender, race, marital status, comorbidity index score, non-mental health outpatient visits and CAP hospitalization in the previous year, and any acute respiratory conditions experienced in the previous 30 days. Analyses of length of stay and inpatient death additionally adjusted for development of bacteremia, and respiratory complications. Table A.5. Sensitivity Analyses of Time since Last PV in Elderly Veterans Hospitalized for Community-Acquired Pneumonia in Fiscal Year 2003 (n=3015)*?Length of Stay Vaccination StatusIRR95% CIP-valuePV within 1 year RefPV within 2 years0.960.87-1.050.3770PV within 3 years0.980.90-1.070.7104PV within 4 years1.020.93-1.110.7261PV within 5 years1.070.98-1.170.1095Inpatient DeathVaccination StatusOR95% CIP-valuePV within 1 year RefPV within 2 years1.050.63-1.730.8634PV within 3 years1.000.61-1.610.9832PV within 4 years1.030.64-1.650.9006PV within 5 years1.180.75-1.870.4674BacteremiaVaccination StatusOR95% CIP-valuePV within 1 year RefPV within 2 years0.870.31-2.440.7939PV within 3 years1.570.66-3.760.3080PV within 4 years2.070.90-4.750.0878PV within 5 years1.830.80-4.190.1558Respiratory ComplicationsVaccination StatusOR95% CIP-valuePV within 1 year RefPV within 2 years0.940.65-1.350.7206PV within 3 years0.880.62-1.260.4953PV within 4 years1.030.73-1.450.8784PV within 5 years0.830.59-1.170.2892IRR: Incident Rate Ratio; OR: Odds Ratio; PV: Pneumococcal Vaccine; FV: Influenza Vaccine* The analyses were conducted among 3015 patients who had prior PV.All analyses have adjusted for patient's age, gender, race, marital status, comorbidity index score, non-mental health outpatient visits and CAP hospitalization in the previous year, and any acute respiratory conditions experienced in the previous 30 days. Analyses of length of stay and inpatient death additionally adjusted for development of bacteremia, and respiratory complications. ................
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