Outcomes associated with observation versus short-stay admission among chest pain patients in the Veterans Health Administration
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 (
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| Veröffentlicht in: | BMC emergency medicine 2016-09, Vol.16 (1), p.38-38, Article 38 |
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| container_title | BMC emergency medicine |
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| creator | Wright, Brad O'Shea, Amy M J Glasgow, Justin M Ayyagari, Padmaja Vaughan-Sarrazin, Mary |
| description | 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 ( |
| doi_str_mv | 10.1186/s12873-016-0103-4 |
| format | Article |
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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.
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.
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.</description><identifier>ISSN: 1471-227X</identifier><identifier>EISSN: 1471-227X</identifier><identifier>DOI: 10.1186/s12873-016-0103-4</identifier><identifier>PMID: 27655080</identifier><language>eng</language><publisher>England: BioMed Central Ltd</publisher><subject>Care and treatment ; Chest pain ; Clinical outcomes ; Consent ; Demographic aspects ; Emergency services ; Funding ; Health aspects ; Hospital administration ; Hospital care ; Mortality ; Pain ; Patient outcomes ; Patients ; R&D ; Research & development ; Software ; Studies ; Veterans</subject><ispartof>BMC emergency medicine, 2016-09, Vol.16 (1), p.38-38, Article 38</ispartof><rights>COPYRIGHT 2016 BioMed Central Ltd.</rights><rights>Copyright BioMed Central 2016</rights><rights>The Author(s). 2016</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c494t-7ae46b2b0058a7b7283a26b09051b2be6bd3050a6c700cfa9651c5822f86ed813</citedby><cites>FETCH-LOGICAL-c494t-7ae46b2b0058a7b7283a26b09051b2be6bd3050a6c700cfa9651c5822f86ed813</cites><orcidid>0000-0002-2674-4951</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC5031353/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC5031353/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,314,723,776,780,860,881,27901,27902,53766,53768</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/27655080$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Wright, Brad</creatorcontrib><creatorcontrib>O'Shea, Amy M J</creatorcontrib><creatorcontrib>Glasgow, Justin M</creatorcontrib><creatorcontrib>Ayyagari, Padmaja</creatorcontrib><creatorcontrib>Vaughan-Sarrazin, Mary</creatorcontrib><title>Outcomes associated with observation versus short-stay admission among chest pain patients in the Veterans Health Administration</title><title>BMC emergency medicine</title><addtitle>BMC Emerg Med</addtitle><description>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).
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.
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.
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.</description><subject>Care and treatment</subject><subject>Chest pain</subject><subject>Clinical outcomes</subject><subject>Consent</subject><subject>Demographic aspects</subject><subject>Emergency services</subject><subject>Funding</subject><subject>Health aspects</subject><subject>Hospital administration</subject><subject>Hospital care</subject><subject>Mortality</subject><subject>Pain</subject><subject>Patient outcomes</subject><subject>Patients</subject><subject>R&D</subject><subject>Research & development</subject><subject>Software</subject><subject>Studies</subject><subject>Veterans</subject><issn>1471-227X</issn><issn>1471-227X</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2016</creationdate><recordtype>article</recordtype><sourceid>BENPR</sourceid><recordid>eNptUk1v1DAQjRCIlsIP4IIsceGSYjv-ygVpVQFFqtQLIG6W40w2rhJ7sZ2teuOn47Bl1SJk2R6N33v2jF9VvSb4nBAl3idClWxqTESZuKnZk-qUMElqSuWPpw_ik-pFSjcYE6lI-7w6oVJwjhU-rX5dL9mGGRIyKQXrTIYe3bo8otAliHuTXfBoDzEtCaUxxFynbO6Q6WeX0npm5uC3yI6QMtoZ58uSHficUInzCOg7ZIjGJ3QJZirCm0L1LuX4R_tl9WwwU4JX9_tZ9e3Tx68Xl_XV9ecvF5ur2rKW5VoaYKKjHcZcGdlJqhpDRYdbzElJg-j6BnNshJUY28G0ghPLFaWDEtAr0pxVHw66u6WbobflhdFMehfdbOKdDsbpxyfejXob9prjhjS8KQLv7gVi-LmUanXpgIVpMh7CkjRRvJW0pZIX6Nt_oDdhib6UV1AMK8bWfzuitmYC7fwQyr12FdUbJhgVTctX1Pl_UGX0MDsbPAyu5B8RyIFgY0gpwnCskWC92kYfbKOLbfRqG80K583D5hwZf33S_AZcV7-B</recordid><startdate>20160921</startdate><enddate>20160921</enddate><creator>Wright, Brad</creator><creator>O'Shea, Amy M J</creator><creator>Glasgow, Justin M</creator><creator>Ayyagari, Padmaja</creator><creator>Vaughan-Sarrazin, Mary</creator><general>BioMed Central Ltd</general><general>BioMed Central</general><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>M0S</scope><scope>M1P</scope><scope>M7N</scope><scope>PIMPY</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope><scope>5PM</scope><orcidid>https://orcid.org/0000-0002-2674-4951</orcidid></search><sort><creationdate>20160921</creationdate><title>Outcomes associated with observation versus short-stay admission among chest pain patients in the Veterans Health Administration</title><author>Wright, Brad ; O'Shea, Amy M J ; Glasgow, Justin M ; Ayyagari, Padmaja ; Vaughan-Sarrazin, Mary</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c494t-7ae46b2b0058a7b7283a26b09051b2be6bd3050a6c700cfa9651c5822f86ed813</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2016</creationdate><topic>Care and treatment</topic><topic>Chest pain</topic><topic>Clinical outcomes</topic><topic>Consent</topic><topic>Demographic aspects</topic><topic>Emergency services</topic><topic>Funding</topic><topic>Health aspects</topic><topic>Hospital administration</topic><topic>Hospital care</topic><topic>Mortality</topic><topic>Pain</topic><topic>Patient outcomes</topic><topic>Patients</topic><topic>R&D</topic><topic>Research & development</topic><topic>Software</topic><topic>Studies</topic><topic>Veterans</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Wright, Brad</creatorcontrib><creatorcontrib>O'Shea, Amy M J</creatorcontrib><creatorcontrib>Glasgow, Justin M</creatorcontrib><creatorcontrib>Ayyagari, Padmaja</creatorcontrib><creatorcontrib>Vaughan-Sarrazin, Mary</creatorcontrib><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central Essentials</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Algology Mycology and Protozoology Abstracts (Microbiology C)</collection><collection>Publicly Available Content Database</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>BMC emergency medicine</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Wright, Brad</au><au>O'Shea, Amy M J</au><au>Glasgow, Justin M</au><au>Ayyagari, Padmaja</au><au>Vaughan-Sarrazin, Mary</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Outcomes associated with observation versus short-stay admission among chest pain patients in the Veterans Health Administration</atitle><jtitle>BMC emergency medicine</jtitle><addtitle>BMC Emerg Med</addtitle><date>2016-09-21</date><risdate>2016</risdate><volume>16</volume><issue>1</issue><spage>38</spage><epage>38</epage><pages>38-38</pages><artnum>38</artnum><issn>1471-227X</issn><eissn>1471-227X</eissn><abstract>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).
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.
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.
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.</abstract><cop>England</cop><pub>BioMed Central Ltd</pub><pmid>27655080</pmid><doi>10.1186/s12873-016-0103-4</doi><tpages>1</tpages><orcidid>https://orcid.org/0000-0002-2674-4951</orcidid><oa>free_for_read</oa></addata></record> |
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| source | DOAJ Directory of Open Access Journals; SpringerLink Journals; Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals; PubMed Central; PubMed Central Open Access; Springer Nature OA Free Journals |
| subjects | Care and treatment Chest pain Clinical outcomes Consent Demographic aspects Emergency services Funding Health aspects Hospital administration Hospital care Mortality Pain Patient outcomes Patients R&D Research & development Software Studies Veterans |
| title | Outcomes associated with observation versus short-stay admission among chest pain patients in the Veterans Health Administration |
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