Trends in Hospitalization vs Observation Stay for Ambulatory Care–Sensitive Conditions

Figueroa, José F.; Burke, Laura; Zheng, Jing; Orav, E. John; Jha, Ashish K.

doi:10.1001/jamainternmed.2019.3177

Cited by 29 publications

(38 citation statements)

References 4 publications

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“… 31 Certain comorbid conditions, such as anemia, may lead to hospitalizations if not well managed, but strategies to effectively manage anemia may reduce hospitalizations in individuals with advanced CKD. 32 Our findings warrant additional research to investigate whether specific primary causes of hospitalization that are representative of ambulatory care–sensitive conditions 22 , 33 , 34 may be preventable by interventions such as telehealth monitoring, 35 , 36 home hospital services, 15 , 37 , 38 or enhanced ambulatory care. 11 , 16 , 17 …”

Section: Discussionmentioning

confidence: 84%

“…We included all hospitalizations, independent of duration or station (emergency department, observation, and inpatient), to determine if any type of hospitalization provided information about an individual’s health. 22 More detailed information about ascertainment of hospitalization and covariate data is provided in the Supplementary Methods .…”

Section: Methodsmentioning

confidence: 99%

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Hospitalization Trajectories and Risks of ESKD and Death in Individuals With CKD

Srivastava

Cai

Mehta

et al. 2021

Kidney International Reports

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Introduction Management of chronic kidney disease (CKD) entails high medical complexity and often results in high hospitalization burden. There are limited data on the associations of longitudinal hospital utilization patterns with adverse clinical outcomes in individuals with CKD. Methods We derived cumulative all-cause hospitalization trajectory groups using latent class trajectory analysis in 3012 participants of the Chronic Renal Insufficiency Cohort (CRIC) Study who were alive and did not reach end-stage kidney disease (ESKD) within 4 years of study entry. Cox proportional hazards models tested the associations between hospitalization trajectory groups and risks of ESKD and death prior to the onset of ESKD (ESKD-censored death). Results Within 4 years of study entry, there were 5658 hospitalizations among 3012 participants. We identified 3 distinct subgroups of individuals with CKD based on cumulative all-cause hospitalization trajectories over 4 years: low-utilizer ( n = 1066), intermediate-utilizer ( n = 1802), and high-utilizer ( n = 144). High-utilizers represented a patient population of lower socioeconomic status who had a greater prevalence of comorbid conditions and lower kidney function compared with intermediate- and low-utilizers. After the 4-year ascertainment period to form the trajectory subgroups, there were 544 ESKD events and 437 ESKD-censored deaths during a median follow-up time of 5.1 years. Compared with low-utilizers, intermediate-utilizers and high-utilizers were at 1.49-fold (95% confidence interval [CI] 1.22–1.84) and 1.75-fold (95% CI 1.20–2.56) higher risk of ESKD in adjusted analyses, respectively. Compared with low-utilizers, intermediate-utilizers and high-utilizers were at 1.48-fold (95% CI 1.17–1.87) and 2.58-fold (95% CI 1.74–3.83) higher risk of ESKD-censored death in adjusted analyses, respectively. Conclusions Trajectories of cumulative all-cause hospitalization identify subgroups of individuals with CKD who are at high risk of ESKD and death.

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Section: Discussionmentioning

confidence: 84%

Section: Methodsmentioning

confidence: 99%

Hospitalization Trajectories and Risks of ESKD and Death in Individuals With CKD

Srivastava

Cai

Mehta

et al. 2021

Kidney International Reports

View full text Add to dashboard Cite

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“…First, not all ACSC admissions are avoidable 4 : differences that we uncovered may not be fully reconcilable. Second, MA plans may simply be better at using intermediary treatment pathways—like admission to observation beds 5 —to avoid ACSC inpatient admissions. Third, we could not adjust for the fact that MA enrollees tend to be younger and healthier than those enrolled in TM.…”

Section: Discussionmentioning

confidence: 99%

Ambulatory Care Sensitive Condition Admission Rates in Younger and Older Traditional Medicare and Medicare Advantage Populations, 2011–2019

Weeks

Wang²,

Smith

et al. 2021

J GEN INTERN MED

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“…13,14 Recent evidence further suggests that observation care may be replacing traditional inpatient hospitalizations or readmissions. 15,16 Lastly, from the patient's perspective, observation stay is likely a similar experience to hospitalized care on inpatient units.…”

Section: Emergency Care Deliveredmentioning

confidence: 99%

Changes in Emergency Department Care Intensity from 2007-16: Analysis of the National Hospital Ambulatory Medical Care Survey

Chou

Baker

Schuur

2020

WestJEM

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Introduction: Emergency departments (ED) in the United States (US) have increasingly taken the central role for the expedited diagnosis and treatment of acute episodic illnesses and exacerbations of chronic diseases, allowing outpatient management to be possible for many conditions that traditionally required hospitalization and inpatient care. The goal of this analysis was to examine the changes in ED care intensity in this context through the changes in ED patient population and ED care provided. Methods: We analyzed the National Hospital Ambulatory Medical Care Survey (NHAMCS) from 2007-2016. Incorporating survey design and weight, we calculated the changes in ED patient characteristics and ED care provided between 2007 and 2016. We also calculated changes in the proportion of visits with low-severity illnesses that may be safely managed at alternative settings. Lastly, we compared ED care received and final ED dispositions by calculating adjusted relative risk (aRR) comparing ED visits in 2007 to 2016, using survey weighted multivariable logistic regression. Results: NHAMCS included 35,490 visits in 2007 and 19,467 visits in 2016, representing 117 million and 146 million ED visits, respectively. Between 2007 and 2016, there was an increase in the proportion of ED patients aged 45-64 (21.0% to 23.6%) and 65-74 (5.9% to 7.5%), while visits with low-severity illnesses decreased from 37.3% to 30.4%. There was a substantial increase in the proportion of Medicaid patients (22.2% to 34.0%) with corresponding decline in the privately insured (36.2% to 28.3%) and the uninsured (15.4% to 8.6%) patients. After adjusting for patient and visit characteristics, there was an increase in the utilization of advanced imaging (aRR 1.29; 95% confidence interval [CI], 1.17-1.41), blood tests (aRR 1.16; 95% CI, 1.10-1.22), urinalysis (aRR 1.22; 95% CI, 1.13-1.31), and visits where the patient received four or more medications (aRR 2.17; 95% CI, 1.88-2.46). Lastly, adjusted hospitalization rates declined (aRR 0.74; 95% CI, 0.64-0.84) while adjusted discharge rates increased (aRR 1.06; 95%CI 1.03-1.08). Conclusion: From 2007 to 2016, ED care intensity appears to have increased modestly, including aging of patient population, increased illness severity, and increased resources utilization. The role of increased care intensity in the decline of ED hospitalization rate requires further study.

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Trends in Hospitalization vs Observation Stay for Ambulatory Care–Sensitive Conditions

Cited by 29 publications

References 4 publications

Hospitalization Trajectories and Risks of ESKD and Death in Individuals With CKD

Hospitalization Trajectories and Risks of ESKD and Death in Individuals With CKD

Ambulatory Care Sensitive Condition Admission Rates in Younger and Older Traditional Medicare and Medicare Advantage Populations, 2011–2019

Changes in Emergency Department Care Intensity from 2007-16: Analysis of the National Hospital Ambulatory Medical Care Survey

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