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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...

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Autores principales: Wright, Brad, O’Shea, Amy M. J., Glasgow, Justin M., Ayyagari, Padmaja, Vaughan-Sarrazin, Mary
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2016
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.
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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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