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Who Has an Unsuccessful Observation Care Stay?

1
Department of Emergency Medicine, University of California, Los Angeles, CA 90024, USA
2
Department of Internal Medicine, Ohio State University, Columbus, OH 43210, USA
3
Divisions of General Internal Medicine and Health Services Research, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095, USA
4
Department of Medicine, Greater Los Angeles Veterans Affairs Healthcare System, Geriatric Research Education and Clinical Center (GRECC), Los Angeles, CA 90073, USA
5
Department of Medicine, University of California, Los Angeles, CA 90024, USA
*
Author to whom correspondence should be addressed.
Healthcare 2018, 6(4), 138; https://doi.org/10.3390/healthcare6040138
Received: 23 August 2018 / Revised: 16 October 2018 / Accepted: 19 November 2018 / Published: 27 November 2018
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PDF [327 KB, uploaded 27 November 2018]

Abstract

Background: With the recent increase use of observation care, it is important to understand the characteristics of patients that utilize this care and either have a prolonged observation care stay or require admission. Methods: We a conducted a retrospective cohort study utilizing 5% sample data from Medicare patients age ≥65 years that was nationally representative in the year 2013. We performed a generalized estimating equation (GEE) logistic regression analysis to evaluate the relationship between an unsuccessful observation stay (defined as either requiring an inpatient admission from observation or having a prolonged observation stay) compared to having successful observation care. Observation cut offs of “successful” vs. “unsuccessful” were based on the CMS 2 midnight rule. Results: Of 154,756 observation stays in 2013, 19 percent (n = 29,604) were admitted to the inpatient service and 34,275 (22.2%) had a prolonged observation stay. The two diagnoses most likely to have an unsuccessful observation stay were intestinal infections (OR 1.56, 95% CI 1.32–1.83) and pneumonia (OR 1.26, 95% CI 1.13–1.41). Conclusion: We found patients placed in observation care with intestinal infections and pneumonia to have the highest odds of either being admitted from observation or having a prolonged observation stay. View Full-Text
Keywords: observation care; outcomes; unsuccessful observation care; observation failure observation care; outcomes; unsuccessful observation care; observation failure
This is an open access article distributed under the Creative Commons Attribution License which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited (CC BY 4.0).
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Gabayan, G.Z.; Doyle, B.; Liang, L.-J.; Donkor, K.; Huang, D. .-C.; Sarkisian, C.A. Who Has an Unsuccessful Observation Care Stay? Healthcare 2018, 6, 138.

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