Chest Pain Patients at Veterans Hospitals Are Increasingly More Likely to Be Observed Than Admitted for Short Stays

Observation stays are an outpatient service used to diagnose and treat patients for extended periods of time while a decision is made regarding inpatient admission or discharge. Although the use of observation stays is increasing, little is known about which patients are observed and which are admit...

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Main Authors: Brad Wright PhD, Amy M. J. O’Shea PhD, Justin M. Glasgow MD, PhD, Padmaja Ayyagari PhD, Mary Vaughan Sarrazin PhD
Format: Article
Language:English
Published: SAGE Publishing 2016-09-01
Series:Inquiry: The Journal of Health Care Organization, Provision, and Financing
Online Access:http://inq.sagepub.com/content/53/0046958016666752.full.pdf
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spelling doaj-ba27e29915604f3f8a8ff4497ef57e082020-11-25T03:16:17ZengSAGE PublishingInquiry: The Journal of Health Care Organization, Provision, and Financing0046-95801945-72432016-09-015310.1177/004695801666675210.1177_0046958016666752Chest Pain Patients at Veterans Hospitals Are Increasingly More Likely to Be Observed Than Admitted for Short StaysBrad Wright PhDAmy M. J. O’Shea PhDJustin M. Glasgow MD, PhDPadmaja Ayyagari PhDMary Vaughan Sarrazin PhDObservation stays are an outpatient service used to diagnose and treat patients for extended periods of time while a decision is made regarding inpatient admission or discharge. Although the use of observation stays is increasing, little is known about which patients are observed and which are admitted for similar periods of time as inpatients. The aim was to identify patient characteristics associated with being observed rather than admitted for a short stay (<48 hours) within the Veterans Health Administration (VHA). In our longitudinal analysis, we used logistic regression within a generalized estimating equation framework to model observation stays as a function of patient characteristics, time trends, and hospital fixed effects. To minimize heterogeneity between groups, we limit our sample to patients with a presenting diagnosis of chest pain. Our analysis includes a total of 121 584 hospital events, which consist of all observation and short-stay admissions for chest pain patients at VHA hospitals between 2005 and 2013. Both the absolute and relative use of observation stays increased markedly over time. The odds of an observation stay were higher among women, but lower among older patients and rural residents. Despite strong evidence that chest pain patients are increasingly more likely to be observed than admitted, suggesting a substitution effect, we find little evidence of within-hospital disparities in VHA observation stay use.http://inq.sagepub.com/content/53/0046958016666752.full.pdf
collection DOAJ
language English
format Article
sources DOAJ
author Brad Wright PhD
Amy M. J. O’Shea PhD
Justin M. Glasgow MD, PhD
Padmaja Ayyagari PhD
Mary Vaughan Sarrazin PhD
spellingShingle Brad Wright PhD
Amy M. J. O’Shea PhD
Justin M. Glasgow MD, PhD
Padmaja Ayyagari PhD
Mary Vaughan Sarrazin PhD
Chest Pain Patients at Veterans Hospitals Are Increasingly More Likely to Be Observed Than Admitted for Short Stays
Inquiry: The Journal of Health Care Organization, Provision, and Financing
author_facet Brad Wright PhD
Amy M. J. O’Shea PhD
Justin M. Glasgow MD, PhD
Padmaja Ayyagari PhD
Mary Vaughan Sarrazin PhD
author_sort Brad Wright PhD
title Chest Pain Patients at Veterans Hospitals Are Increasingly More Likely to Be Observed Than Admitted for Short Stays
title_short Chest Pain Patients at Veterans Hospitals Are Increasingly More Likely to Be Observed Than Admitted for Short Stays
title_full Chest Pain Patients at Veterans Hospitals Are Increasingly More Likely to Be Observed Than Admitted for Short Stays
title_fullStr Chest Pain Patients at Veterans Hospitals Are Increasingly More Likely to Be Observed Than Admitted for Short Stays
title_full_unstemmed Chest Pain Patients at Veterans Hospitals Are Increasingly More Likely to Be Observed Than Admitted for Short Stays
title_sort chest pain patients at veterans hospitals are increasingly more likely to be observed than admitted for short stays
publisher SAGE Publishing
series Inquiry: The Journal of Health Care Organization, Provision, and Financing
issn 0046-9580
1945-7243
publishDate 2016-09-01
description Observation stays are an outpatient service used to diagnose and treat patients for extended periods of time while a decision is made regarding inpatient admission or discharge. Although the use of observation stays is increasing, little is known about which patients are observed and which are admitted for similar periods of time as inpatients. The aim was to identify patient characteristics associated with being observed rather than admitted for a short stay (<48 hours) within the Veterans Health Administration (VHA). In our longitudinal analysis, we used logistic regression within a generalized estimating equation framework to model observation stays as a function of patient characteristics, time trends, and hospital fixed effects. To minimize heterogeneity between groups, we limit our sample to patients with a presenting diagnosis of chest pain. Our analysis includes a total of 121 584 hospital events, which consist of all observation and short-stay admissions for chest pain patients at VHA hospitals between 2005 and 2013. Both the absolute and relative use of observation stays increased markedly over time. The odds of an observation stay were higher among women, but lower among older patients and rural residents. Despite strong evidence that chest pain patients are increasingly more likely to be observed than admitted, suggesting a substitution effect, we find little evidence of within-hospital disparities in VHA observation stay use.
url http://inq.sagepub.com/content/53/0046958016666752.full.pdf
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