Observation‐status patients in children's hospitals with and without dedicated observation units in 2011

Macy, Michelle L.; Hall, Matthew; Fieldston, Evan S.; Shanley, Leticia A.; Hronek, Carla; Hain, Paul D.; Shah, Samir S.

doi:10.1002/jhm.2339

Cited by 12 publications

(9 citation statements)

References 23 publications

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“…The second most reported service was observation units, with over 50% of urban EDs and 35% of rural EDs indicating presence of an ED observation unit. As urban hospitals are usually higher volume than rural, our finding is consistent with literature demonstrating that observation units are more commonly found in higher volume hospitals 24. While lower rates of observation units in rural EDs may reflect less perceived need or interest, the finding that one-third of rural EDs report their presence speaks to the penetration of this model of care in avoiding admission.…”

Section: Discussionsupporting

confidence: 89%

Are Rural and Urban Emergency Departments Equally Prepared to Reduce Avoidable Hospitalizations?

Greenwood-Ericksen

Macy

Ham

et al. 2019

WestJEM

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Introduction Attempts to reduce low-value hospital care often focus on emergency department (ED) hospitalizations. We compared rural and urban EDs in Michigan on resources designed to reduce avoidable admissions. Methods A cross-sectional, web-based survey was emailed to medical directors and/or nurse managers of the 135 hospital-based EDs in Michigan. Questions included presence of clinical pathways, services to reduce admissions, and barriers to connecting patients to outpatient services. We performed chi-squared comparisons, regression modeling, and predictive margins. Results Of 135 EDs, 64 (47%) responded with 33 in urban and 31 in rural counties. Clinical pathways were equally present in urban and rural EDs (67% vs 74%, p=0.5). Compared with urban EDs, rural EDs reported greater access to extended care facilities (21% vs 52%, p=0.02) but less access to observation units (52% vs 35%, p=0.04). Common barriers to connecting ED patients to outpatient services exist in both settings, including lack of social support (88% and 76%, p=0.20), and patient/family preference (68% and 68%, p=1.0). However, rural EDs were more likely to report time required for care coordination (88% vs 66%, p=0.05) and less likely to report limitations to home care (21% vs 48%, p=0.05) as barriers. In regression modeling, ED volume was predictive of the presence of clinical pathways rather than rurality. Conclusion While rural-urban differences in resources and barriers exist, ED size rather than rurality may be a more important indicator of ability to reduce avoidable hospitalizations.

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Section: Discussionsupporting

confidence: 89%

Are Rural and Urban Emergency Departments Equally Prepared to Reduce Avoidable Hospitalizations?

Greenwood-Ericksen

Macy

Ham

et al. 2019

WestJEM

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“…Whereas numerous previous studies across a variety of pediatric subspecialties have used the standardized cost methods developed within the PHIS Database, ours is the first analysis to date to compare and contrast these methods with traditional methodology to understand the implications. 1,[12][13][14] Several strengths and limitations are Median, 25 th , and 75 th percentiles were all slightly lower with the standardized cost method vs the cost-to-charge ratio method, both overall and across The Society of Thoracic Surgeons-European Association for Cardiothoracic Surgery (STAT) categories.…”

Section: Commentmentioning

confidence: 99%

Estimating Resource Utilization in Congenital Heart Surgery

Pasquali

Chiswell

Hall

et al. 2020

The Annals of Thoracic Surgery

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Background. Optimal methods to assess resource utilization in congenital heart surgery remain unclear. We compared traditional cost-to-charge ratio methods with newer standardized cost methods that aim to more directly assess resources consumed.Methods. Clinical data from The Society of Thoracic Surgeons Database were linked with resource use data from the Pediatric Health Information Systems Database (2010 to 2015). Standardized cost methods specific to the congenital heart surgery population were developed and compared with cost-to-charge ratio methods. Resource use in the overall population and variability across hospitals were described using hierarchical mixed effect models adjusting for case-mix.Results. Overall, 43 hospitals (65,331 patients) were included. There were minimal population-level differences in the distribution of resource use as estimated by the two methods. At the hospital level, there was less apparent variability in resource use across centers with the standardized cost vs cost-to-charge ratio method,

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“…A substantial portion of inpatient hospitalizations are assigned to observation status, which typically has a lower hospital reimbursement rate than regular admissions. [11][12][13][14] As many as onethird of pediatric discharges from hospitals reporting observation status in the 2010 Pediatric Health Information System had this designation. 15 Administrative databases, including the American Hospital Association database used for this study, that exclude observation stays likely miscalculate inpatient use.…”

mentioning

confidence: 99%

The Role of Financial Drivers in the Regionalization of Pediatric Care

Riese

Alverson

2021

Pediatrics

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Observation‐status patients in children's hospitals with and without dedicated observation units in 2011

Abstract: BACKGROUND: Pediatric observation units (OUs) have demonstrated reductions in lengths of stay (LOS) and costs of care. Hospital-level outcomes across all observationstatus stays have not been evaluated in relation to the presence of a dedicated OU in the hospital.

Cited by 12 publications

References 23 publications

Are Rural and Urban Emergency Departments Equally Prepared to Reduce Avoidable Hospitalizations?

Are Rural and Urban Emergency Departments Equally Prepared to Reduce Avoidable Hospitalizations?

Estimating Resource Utilization in Congenital Heart Surgery

The Role of Financial Drivers in the Regionalization of Pediatric Care

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