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Outcomes associated with observation versus short-stay admission among chest pain patients in the Veterans Health Administration
BACKGROUND: To determine the extent to which 30- and 90-day hospital readmission and mortality rates differ as a function of whether a chest pain patient is placed in observation status or admitted to the hospital for a short-stay (<48 h). METHODS: Using 114,043 observation stays and short-stay a...
Autores principales: | , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BioMed Central
2016
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5031353/ https://www.ncbi.nlm.nih.gov/pubmed/27655080 http://dx.doi.org/10.1186/s12873-016-0103-4 |
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author | Wright, Brad O’Shea, Amy M. J. Glasgow, Justin M. Ayyagari, Padmaja Vaughan-Sarrazin, Mary |
author_facet | Wright, Brad O’Shea, Amy M. J. Glasgow, Justin M. Ayyagari, Padmaja Vaughan-Sarrazin, Mary |
author_sort | Wright, Brad |
collection | PubMed |
description | BACKGROUND: To determine the extent to which 30- and 90-day hospital readmission and mortality rates differ as a function of whether a chest pain patient is placed in observation status or admitted to the hospital for a short-stay (<48 h). METHODS: Using 114,043 observation stays and short-stay admissions for chest pain at Veterans Health Administration hospitals between 2005 and 2013, we estimated event-level logistic regression models using a generalized estimating equation framework to predict 30 and 90-day readmissions and mortality as a function of whether the patient had an observation stay or a short-stay admission. We also adjusted for a variety of patient characteristics and unobserved time-invariant hospital factors. RESULTS: Relative to the short-stay inpatient group, veterans with chest pain who were placed in observation status were significantly more likely to be female (7.0 % vs. 6.4 %, White (76.6 % vs. 71.0 %, and from a rural area (28.3 % vs. 20.2 %). There were no other meaningful differences between the groups. Veterans with chest pain who were placed in observation status had 25 % lower odds of dying within 30 days (95 % confidence interval [CI]: 3 % – 43 %) and 12 % lower odds of a 30-day readmission (95 % CI: 6 % – 17 %) compared to those admitted as short-stay inpatients. Neither 90-day outcome was significantly associated with placement in observation status. Patient demographics were also important predictors of mortality and readmissions. CONCLUSIONS: There are clinically observable differences in outcomes between patients admitted to observation and those admitted as short-stay inpatients. We find no evidence that the increase in observation stays reflects a lack of proper care for patients placed in observation status. |
format | Online Article Text |
id | pubmed-5031353 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2016 |
publisher | BioMed Central |
record_format | MEDLINE/PubMed |
spelling | pubmed-50313532016-09-29 Outcomes associated with observation versus short-stay admission among chest pain patients in the Veterans Health Administration Wright, Brad O’Shea, Amy M. J. Glasgow, Justin M. Ayyagari, Padmaja Vaughan-Sarrazin, Mary BMC Emerg Med Research Article BACKGROUND: To determine the extent to which 30- and 90-day hospital readmission and mortality rates differ as a function of whether a chest pain patient is placed in observation status or admitted to the hospital for a short-stay (<48 h). METHODS: Using 114,043 observation stays and short-stay admissions for chest pain at Veterans Health Administration hospitals between 2005 and 2013, we estimated event-level logistic regression models using a generalized estimating equation framework to predict 30 and 90-day readmissions and mortality as a function of whether the patient had an observation stay or a short-stay admission. We also adjusted for a variety of patient characteristics and unobserved time-invariant hospital factors. RESULTS: Relative to the short-stay inpatient group, veterans with chest pain who were placed in observation status were significantly more likely to be female (7.0 % vs. 6.4 %, White (76.6 % vs. 71.0 %, and from a rural area (28.3 % vs. 20.2 %). There were no other meaningful differences between the groups. Veterans with chest pain who were placed in observation status had 25 % lower odds of dying within 30 days (95 % confidence interval [CI]: 3 % – 43 %) and 12 % lower odds of a 30-day readmission (95 % CI: 6 % – 17 %) compared to those admitted as short-stay inpatients. Neither 90-day outcome was significantly associated with placement in observation status. Patient demographics were also important predictors of mortality and readmissions. CONCLUSIONS: There are clinically observable differences in outcomes between patients admitted to observation and those admitted as short-stay inpatients. We find no evidence that the increase in observation stays reflects a lack of proper care for patients placed in observation status. BioMed Central 2016-09-21 /pmc/articles/PMC5031353/ /pubmed/27655080 http://dx.doi.org/10.1186/s12873-016-0103-4 Text en © The Author(s). 2016 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. |
spellingShingle | Research Article Wright, Brad O’Shea, Amy M. J. Glasgow, Justin M. Ayyagari, Padmaja Vaughan-Sarrazin, Mary Outcomes associated with observation versus short-stay admission among chest pain patients in the Veterans Health Administration |
title | Outcomes associated with observation versus short-stay admission among chest pain patients in the Veterans Health Administration |
title_full | Outcomes associated with observation versus short-stay admission among chest pain patients in the Veterans Health Administration |
title_fullStr | Outcomes associated with observation versus short-stay admission among chest pain patients in the Veterans Health Administration |
title_full_unstemmed | Outcomes associated with observation versus short-stay admission among chest pain patients in the Veterans Health Administration |
title_short | Outcomes associated with observation versus short-stay admission among chest pain patients in the Veterans Health Administration |
title_sort | outcomes associated with observation versus short-stay admission among chest pain patients in the veterans health administration |
topic | Research Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5031353/ https://www.ncbi.nlm.nih.gov/pubmed/27655080 http://dx.doi.org/10.1186/s12873-016-0103-4 |
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