Differences in designations of observation care in US freestanding children's hospitals: Are they virtual or real?

Macy, Michelle L.; Hall, Matthew; Shah, Samir S.; Hronek, Carla; Beccaro, Mark A. Del; Hain, Paul D.

doi:10.1002/jhm.949

Cited by 42 publications

(40 citation statements)

References 19 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…16 Hospital admissions coded as "observation" were counted as an admission. 17,18 We identified medication delivery by using the National Drug Code Directory, 19 and laboratory and radiology testing was identified by using charges for such testing.…”

Section: Health Services Delivered During Ed Visitsmentioning

confidence: 99%

Characteristics of Recurrent Utilization in Pediatric Emergency Departments

et al. 2014

Self Cite

View full text Add to dashboard Cite

WHAT'S KNOWN ON THIS SUBJECT: Although frequent utilizers of emergency departments (EDs) are targeted for quality improvement initiatives across the United States, little is known about the health services these patients receive in the ED.WHAT THIS STUDY ADDS: Eight percent of children account for 24% of ED visits and 31% of all costs. Frequent utilizers of pediatric EDs, especially infants without a chronic condition, are least likely to need medications, testing, and hospital admission during their ED visits. abstract BACKGROUND AND OBJECTIVE: Nationally, frequent utilizers of emergency departments (EDs) are targeted for quality improvement initiatives. The objective was to compare the characteristics and ED health services of children by their ED visit frequency. METHODS:A retrospective study in 1 896 547 children aged 0 to 18 years with 3 263 330 visits to 37 EDs in 2011. The number of ED visits per child within 365 days of their first visit was counted. Patient characteristics (age, chronic condition) and ED care (medications, testing [laboratory and radiographic], and hospital admission) were assessed. We evaluated the relationship between patient characteristics and ED health services received with multivariable regression. RESULTS:Children with $4 ED visits (8%) accounted for 24% of all visits and 31% ($1.4 billion) of all costs. As visit frequency increased from 1 to $4, the percentage of children aged ,1 year increased (12.1% to 33.2%) and the percentage of children without a chronic condition decreased (81.9% to 45.6%) (P , .001 for both). Children with $4 ED visits had a higher percentage of visits without medication administration (aside from acetaminophen or ibuprofen), testing, or hospital admission when compared with children with 1 visit (35.4% vs 29.0%; P , .001). Children with $4 ED visits who were aged ,1 year (odds ratio: 3.8; 95% confidence interval: 3.7-3.9) and who were without a chronic condition (odds ratio: 3.1; 95% confidence interval: 3.0-3.1) had the highest likelihood of experiencing this type of visit. CONCLUSIONS:With a disproportionate share of pediatric ED cost and utilization, frequent utilizers, especially infants without a chronic condition, are the least likely to need medications, testing, and hospital admission. Pediatrics 2014;134:e1025-e1031 AUTHORS:

show abstract

Section: Health Services Delivered During Ed Visitsmentioning

confidence: 99%

Characteristics of Recurrent Utilization in Pediatric Emergency Departments

et al. 2014

Self Cite

View full text Add to dashboard Cite

show abstract

“…We found that ED visits for children with observationprone diagnoses were widely distributed across hospitals, ranging from large freestanding children's hospitals to small community hospitals. Pediatric observation status patients in children's hospitals typically receive care in inpatient settings, 7 with resource utilization that is comparable to patients with similar diagnoses admitted as inpatients. 8 Several single-center studies suggest that children with select diagnoses can be treated effectively in pediatric observation units with potential for shorter length of stay and costs savings.…”

Section: Discussionmentioning

confidence: 99%

Trends in Observation‐prone Emergency Department Visits Among Michigan Children, 2007–2011

Macy

Cohn

Clark

2015

Academic Emergency Medicine

Self Cite

View full text Add to dashboard Cite

Objectives: To the best of the authors' knowledge, admission of children under observation status in community hospitals has not been examined. The hypothesis of this study was that there has been an increase in observation charge code use over time and variations in the application of observation charge codes across hospital types.Methods: This was a cross-sectional analysis of 5 years (2007 through 2011) of administrative claims data from Michigan residents enrolled in Medicaid, Blue Cross/Blue Shield of Michigan preferred provider organization, and Blue Cross Network health maintenance organization compiled into a single data set. Emergency department (ED) visits to facilities in Michigan made by children (younger than 18 years) were selected. Observation-prone ED visits were identified based on the presence of International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes. Counts of observationprone ED visits were determined and descriptive statistics were calculated. Changes over time in the proportion of visits with observation charge codes by hospital type were assessed with chi-square analysis.

show abstract

“…all observation status patients are cared for in dedicated observation units. 9 This, in essence, means that most children under observation status are cared for in ''virtual observation'' by inpatient teams using inpatient beds. If observation patients are treated in inpatient beds and consume the same resources as inpatients, then cost-savings based on reimbursement contracts with payers may not reflect an actual reduction in services.…”

Section: Discussionmentioning

confidence: 99%

“…While this decision is clearly reserved for the admitting physician, the process is not standardized across hospitals. 9 Some institutions have Utilization Managers on site to help guide decision-making, while others allow the assignment to be made by physicians without specific guidance. As a result, some patients may be assigned to observation status at admission and reassigned to inpatient status following Utilization Review, which may bias our results toward overestimation of the number of observation stays that converted to inpatient status.…”

Section: Limitationsmentioning

confidence: 99%

“…While the decision to admit a patient is ultimately at the discretion of the ordering physician, many hospitals use predetermined criteria to assign observation status to patients admitted to observation and inpatient units. 9 Treatment provided under observation status is designated by hospitals and payers as outpatient care, even when delivered in an inpatient bed. 10 As outpatient-designated care, observation cases do not enter publicly available administrative datasets of hospital discharges that have traditionally been used to understand hospital resource utilization, including the National Hospital Discharge Survey and the Kid's Inpatient Database.…”

mentioning

confidence: 99%

See 1 more Smart Citation

Pediatric observation status: Are we overlooking a growing population in children's hospitals?

Macy

Hall

Shah

et al. 2012

Journal of Hospital Medicine

Self Cite

View full text Add to dashboard Cite

BACKGROUND: Inpatient administrative datasets often exclude observation stays, as observation is considered to be outpatient care. The extent to which this status is applied to pediatric hospitalizations is not known. OBJECTIVE: To characterize trends in observation status code utilization and 1‐day stays among children admitted from the emergency department (ED), and to compare patient characteristics and outcomes associated with observation versus inpatient stays. DESIGN: Retrospective longitudinal analysis of the 2004–2009 Pediatric Health Information System (PHIS). SETTING: Sixteen US freestanding children's hospitals contributing outpatient and inpatient data to PHIS. PATIENTS: Admissions to observation or inpatient status following ED care in study hospitals. MEASUREMENTS: Proportions of observation and 1‐day stays among all admissions from the ED were calculated each year. Top ranking discharge diagnoses and outcomes of observation were determined. Patient characteristics, discharge diagnoses, and return visits were compared for observation and 1‐day stays. RESULTS: The proportion of short‐stays (including both observation and 1‐day stays) increased from 37% to 41% between 2004 and 2009. Since 2007, observation stays have outnumbered 1‐day stays. In 2009, more than half of admissions from the ED for 6 of the top 10 ranking discharge diagnoses were short‐stays. Fewer than 25% of observation stays converted to inpatient status. Return visits and readmissions following observation were no more frequent than following 1‐day stays. CONCLUSIONS: Children admitted under observation status make up a substantial proportion of acute care hospitalizations. Analyses of inpatient administrative databases that exclude observation stays likely result in an underestimation of hospital resource utilization for children. Journal of Hospital Medicine 2012; © 2012 Society of Hospital Medicine

show abstract

Differences in designations of observation care in US freestanding children's hospitals: Are they virtual or real?

Cited by 42 publications

References 19 publications

Characteristics of Recurrent Utilization in Pediatric Emergency Departments

Characteristics of Recurrent Utilization in Pediatric Emergency Departments

Trends in Observation‐prone Emergency Department Visits Among Michigan Children, 2007–2011

Pediatric observation status: Are we overlooking a growing population in children's hospitals?

Contact Info

Product

Resources

About