In 2014, US healthcare spending exceeded $3.0 trillion with nearly 1/3 spent on hospitalizations. Informed by real-world data from an Electronic Health Record (EHR) database of clinical and administrative records spanning 273 million encounters for 60 million patients in 600+ hospitals across the US, Boston Strategic Partners (BSP) Clinical Insights report, Hospital-Treated Pneumonia Part 1: Diagnosis, estimates 30% of all hospital discharges involve treatment of infectious organisms. Pneumonia is responsible for an estimated 12% of all hospital stays. At an average cost of $15,500 per occurrence, we estimate that hospitalizations for severe infections account for around $212 billion in annual spending or 7% of total healthcare expenditure. In this report, we conduct an in-depth analysis of pneumonia patient characteristics, costs, and laboratory testing. The Hospital-Treated Pneumonia Diagnosis Report is available at www.bostonsp.com/reports. Gram-negative bacteria are the likely causative agents of most pneumonia infections. From 2010-2015, drug resistant organisms caused a surprising 20% of bacterial pneumonia infections. Hospital-Treated Pneumonia Part 1: Diagnosis is part one of a two-part series on hospital-treated pneumonia. This report provides quantitative, objective data focused on the diagnosis of pneumonia captured by hospitals contributing to Cerner Health Facts. This data provides real-world patient encounters and reflects real physician diagnostic decisions and encounter characteristics (e.g. admissions and lab testing) in key areas, such as antibiotic resistant pathogens.

1. Boston Strategic Partners, Inc.
Business and Clinical Strategy ● Health Economics & Outcomes Research
Medical Communications ● Regulatory Strategy ● Financial Advisory
4 Wellington St. Suite 3, Boston, MA 02118 ● http://www.bostonsp.com ● realworldreports@bostonsp.com ● 617-446-3440
Real World Insights:
Hospital-Treated Pneumonia Part 1: Diagnosis
July 2017

2. Abstract
In 2014, US healthcare spending exceeded $3.0 trillion with nearly 1/3 spent on hospitalizations. Informed by real-world data
from an Electronic Health Record (EHR) database of clinical and administrative records spanning 273 million encounters for 60
million patients in 600+ hospitals across the US, Boston Strategic Partners (BSP) estimates 30% of all hospital discharges
involve treatment of infectious organisms. Pneumonia is responsible for an estimated 12% of all hospital stays. At an average
cost of $15,500 per occurrence, we estimate that hospitalizations for severe infections account for around $212 billion in annual
spending or 7% of total healthcare expenditure. In this report, we conduct an in-depth analysis of Pneumonia patient
characteristics, costs, and laboratory testing.
Gram-negative bacteria are the likely causative agents of most Pneumonia infections. From 2010-2015, drug resistant organisms
caused a surprising 20% of bacterial Pneumonia infections.
Hospital-Treated Pneumonia Part 1: Diagnosis is part one of a two-part series on hospital-treated Pneumonia. This report
provides quantitative, objective data focused on the diagnosis of Pneumonia captured by hospitals contributing to Cerner Health
Facts. This data provides real-world patient encounters and reflects real physician diagnostic decisions and encounter
characteristics (e.g. admissions and lab testing) in key areas, such as antibiotic resistant pathogens.
• Focused on Pneumonia requiring hospitalization, detailed analysis of over 680K hospital discharges from 2009 to 2015
(including projections through 2019)
• Epidemiology of infection in the US, including demographic information, growth, overall patient encounter attributes, and most
common causative agents
• An overview of patients with Pneumonia in the US, including region, gender, and age breakdown, payer type, infection type,
associated patient comorbidities, and antibiotic usage
• Analysis of Length of Stay (LOS), total costs, and admission data and how they correlate with the following:
• Age of patient
• APACHE II score
• Care setting
• Examination of frequently ordered lab tests and cultures with data on turnaround time (TAT) and results
• Discussion of the increasing concern regarding antibiotic-resistant organisms
• Growth
• Costs
• Outcomes
• LOS
2

3. Table of Contents
3
1. Patient Flow
2. Executive Summary
3. Incidence and Impact of Disease
a. Incidence
b. Length of Stay
c. Total Cost
4. Patient Demographics
a. Age
b. Insurance type
c. Gender
d. Region
e. Mortality
f. Comorbid Conditions
5. Patient Segmentation by Diagnostic Testing
a. Causative Etiologic Agent
6. Length of Stay and Cost by Patient Segment
a. Age at Admission
b. APACHE II Score
c. First Care Setting
7. Patient Flow through the Hospital
a. Admission Site
b. Lab Testing
c. Lab TAT
d. Results
e. Etiology
8. Drug Resistant Pneumonia
a. Current Trends
b. Costs
c. Comorbidity
d. LOS
e. Mortality
9. Database Overview
10. Methodology

4. Executive Summary
Methodology Overview:
Using an electronic health record (EHR) database with information collected from 614 hospitals across
the US, we evaluated overall trends in the diagnosis, treatment, costs, and outcomes associated with
acute infections requiring hospitalization (n=681,251 patients from 2010-2015). In addition, we
conducted an in-depth analysis for specific types of infections. This report will focus on the treatment
of Pneumonia in the hospital.
Incidence and Impact of Disease:
In 2014, the US healthcare spending crossed $3.0 trillion with nearly 1/3 ($971 billion) spent on
hospitalizations.1 In 2013, an estimated 13.7 million hospital discharges (~30% of all hospital
discharges) involved treatment of infectious organisms.2
At an average cost of $15,500 per occurrence, we estimate that hospitalization for severe infections
account for approximately $212 billion in annual spending (7% of total healthcare expenditure).
Pneumonia accounts for approximately 1.14 MM inpatient stays per year, or ~12% of all hospital stays.
Of these patients, approximately 20% have confirmed bacterial agents as the cause of infection.
4
Source: CMS, 2016, HCUP, 2016, BSP EHR database

5. The dataset represents 10% of US hospitals and 16% of the US population
with data from over 273MM patient visits
5
Pacific
Hospitals: 43 (7%)
Visits: 23.2 MM
Patients: 4.6 MM (9%)
Mountain
Hospitals: 58 (11%)
Visits: 11.9 MM
Patients: 1.8 MM (8%)
West North Central
Hospitals: 83 (11%)
Visits: 41.5 MM
Patients: 6.5 MM (31%)
East North Central
Hospitals: 80 (9%)
Visits: 19.9 MM
Patients: 3.8 MM (8%)
West South Central
Hospitals: 58 (6%)
Visits: 15.8 MM
Patients: 3.2 MM (8%)
New England
Hospitals: 24 (10%)
Visits: 30.3 MM
Patients: 2.9 MM (19%)
Mid Atlantic
Hospitals: 95 (19%)
Visits: 84.6 MM
Patients: 16.1 MM (39%)
South Atlantic
Hospitals: 42 (5%)
Visits: 7.7 MM
Patients: 1.8 MM (3%)
East South Central
Hospitals: 110 (23%)
Visits: 37.8 MM
Patients: 8.9 MM (47%)
Dataset (% of total US market)
Overall
614 Hospitals
273 MM Patient Visits
56 MM Unique Patients
January 2000 – March 2015
Source: BSP EHR database, HCUP, US Census