The increase in the number of hospitalizations for severe sepsis coupled with declining in-hospital mortality and declining geometric mean cost per case may reflect improvements in care or increases in discharges to skilled nursing facilities; however, these findings more likely represent changes in documentation and hospital coding practices that could bias efforts to conduct national surveillance.

No abstract

NEUMONIA IS A LEADING CAUSE of morbidity and mortality among US adults, resulting in more than 1 million annual hospital admissions and accounting for more than $10.5 billion in aggregate costs. 1,2 Given its public health significance, pneumonia has been the target of quality improvement activities for nearly 2 decades. This began with the publication of clinical practice guidelines in the early 1990s, 3 was followed by a series of statewide and national quality improvement initiatives, 4 and more recently has included public reporting and pay-for-performance programs led by the Joint Commission and the Centers for Medicare & Medicaid Services (CMS) and other payers. 5,6 These efforts have been associated with favorable trends in adherence to recommended processes of care, 7-10 including the choice and timely administration of antibiotics. At the same time, several epidemiologic analyses have reported that survival among pneumonia patients appears to be improving, suggesting that clinical advances, improvements in health care quality, or both are having beneficial effects. 11-14 Although the decline in pneumonia mortality may reflect real improvements in clinical outcomes, in the absence of any For editorial comment see p 1433.