Utilization of Dysphagia Services Among Older Adults Hospitalized With Pneumonia in a Large Sample of <scp>US</scp> Hospitals
Bibliographic record
Abstract
BACKGROUND: Pneumonia is a major cause of morbidity and mortality among older adults, with increased risk for individuals with neurodegenerative conditions. Although dysphagia is a significant risk factor for pneumonia pathogenesis, there is a paucity of data on dysphagia management in patients hospitalized with pneumonia. Therefore, we examined dysphagia service utilization rates and associated clinical factors for older adults hospitalized with pneumonia. METHODS: We identified community-acquired and aspiration pneumonia (CAP and Asp-PNA) general care hospitalizations among older adults (age ≥ 60) between April 2022 and December 2023 using the Premier Healthcare Database. Factors that influenced utilization of three primary dysphagia services-clinical evaluations, instrumental evaluations (e.g., videofluoroscopy), and therapy-were examined in three generalized linear mixed models with a random effect for hospital and adjusted for patient demographics and hospital characteristics. RESULTS: Our sample included 195,782 older adults (51.7% female; 19.3% ND; 15.7% Asp-PNA) across 943 hospitals, and 23.6% received a clinical evaluation, 6.8% an instrumental evaluation, and 11.2% therapy. Generalized linear mixed models of clinical evaluations, instrumental evaluations, and therapy revealed significant associations of Asp-PNA, neurodegenerative disease (ND), and their interaction. The association between Asp-PNA and dysphagia services was greater in the non-ND group (clinical: OR = 9.57; instrumental: OR = 9.67; therapy: OR = 8.66) and attenuated in the ND group (clinical: OR = 5.49; instrumental: OR = 4.66; therapy: OR = 4.20). Similarly, the association between ND and dysphagia services was greater for those with CAP (clinical: OR = 2.85; instrumental: OR = 2.03; therapy: OR = 3.11) and dampened for Asp-PNA (clinical: OR = 1.64; instrumental: OR = 0.98; therapy: OR = 1.50). CONCLUSIONS: Dysphagia services were provided to less than one quarter of older adults with pneumonia in our large U.S. cohort, although rates were higher among patients with Asp-PNA and neurodegenerative disease. Future research should focus on using dysphagia screening tools to promote appropriate referrals to dysphagia services for pneumonia patients.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.004 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.001 | 0.002 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".