Incidence, Mortality, Costs Increased Among Medicaid Patients With NVHAP

A recent study calculated the incidence and mortality rates for patients with Medicaid coverage who had nonventilator hospital-acquired pneumonia (NVHAP) and found possible associations between greater health care costs and NVHAP diagnosis.

Although efforts have reduced the rates of many hospital-acquired infections (HAI), similar effort has not seen toward decreasing rates of nonventilator hospital-acquired pneumonia (NVHAP), despite NVHAP’s correlation with substantial mortality and health care costs for patients in acute care.

Published in American Journal of Infection Control, study results revealed an NVHAP incidence of 2.63 per 1000 patient-days, a 7.76% morality rate, and $20,189 in additional costs over a 5-year period for patients with NVHAP who have Medicaid coverage.

An inpatient NVHAP diagnosis was defined as a pneumonia diagnosis 48 hours or more after admission to a hospital. Pneumonia must not have been present at the time of admission nor associated with mechanical ventilation.

Inpatient and outpatient medical care, dental services, and administrative claims data were collected from the IBM Watson MarketScan Medicaid Database across 13 states. This study included all Medicaid beneficiaries admitted to a hospital at some point between 2015 and 2019.

From 2015 to 2019, 75,909 of 5,668,417 Medicaid beneficiaries were given an NVHAP diagnosis, which translated into the overall NVHAP incidence of 2.63 per 1000 patient-days.

Patients aged 45 to 64 years made up 19.1% of the study sample but had the highest NVHAP incidence of 5.18 per 1000 patient-days. A slightly lower NVHAP incidence of 4.47 per 1000 patient-days was found in patients 65 years or older. Patients aged 0 to 17 years had the lowest NVHAP incidence of 0.71 per 1000 patient-days. These data suggest that younger patients are at risk for NVHAP although they are not generally thought to be, the researchers noted.

In addition, male patients had a higher NVHAP incidence compared with female patients, despite the study including about twice as many women (n = 3,625,421) as men (n = 1,971,500). The NVHAP incidence for males was 3.1 per 1000 patient-days vs 2.32 among females.

The overall NVHAP 5-year mortality rate (from 2015 to 2019) was 7.76%. By age, the highest mortality rates were 9.39%, which was seen among patients 65 years or older, and 8.64% found in patients aged 45 to 64 years.

After a diagnosis of NVHAP, total health care costs as a percentage of total NVHAP encounters increased by 28.8%. Costs as a percentage of total inpatient costs increased by 14.6%.

A limitation of this study is that variable accuracy could not be confirmed because of the use of administrative claims data and diagnostic-related group codes to verify pneumonia diagnoses. The researchers also noted that a pneumonia diagnosis is not always straightforward. In addition, study results are not generalizable to populations beyond Medicaid beneficiaries. As the results of this study are purely descriptive, interpretations of these findings are limited.

“These NVHAP incidence and cost findings are consistent with previous research, providing further support that NVHAP prevention in the United States health care system is a critical patient safety issue,” the researchers concluded.


Giuliano KK, Baker D, Thakkar-Samtani M, Scannapieco FA, Heaton LJ, Frantsve-Hawley J. Incidence, mortality, and cost trends in nonventilator hospital-acquired pneumonia in Medicaid beneficiaries, 2015-2019. Am J Infect Control. Published online June 19, 2022. doi:10.1016/j.ajic.2022.06.016

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