Use or Abuse? A Qualitative Study of Emergency Physicians' Views on Use of Observation Stays at Three Hospitals in the United States and England

Martin, Graham; Wright, Brad; Ahmed, Azeemuddin; Banerjee, Jay; Mason, Suzanne; Roland, Damian

doi:10.1016/j.annemergmed.2016.08.458

Cited by 12 publications

(9 citation statements)

References 35 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…These predictors were selected to contextualize a major clinical predictor of hospitalization (abnormal vital signs) with two nonclinical factors (time of ED arrival, oncology referral to ED) suggested to affect hospitalization decisions. 18,20 The multivariable model for hospitalization also adjusted for: patient sex, age, year of ED visit, Charlson comorbidity index at the time of cancer diagnosis, cancer type, whether advancedstage cancer, and initial cancer treatment modalities. SAS 9.4 (SAS Institute, Cary, NC) and STATA/MP 15.1 STATA, College Station, TX) were used for statistical analyses.…”

Section: Outcomes and Statistical Analysismentioning

confidence: 99%

Characteristics of Emergency Department Visits and Select Predictors of Hospitalization for Adults With Newly Diagnosed Cancer in a Safety-Net Health System

Hong

Sadeghi

Harvey

et al. 2019

JOP

View full text Add to dashboard Cite

PURPOSE: There is little description of emergency department (ED) visits and subsequent hospitalizations among a safety-net cancer population. We characterized patterns of ED visits and explored nonclinical predictors of subsequent hospitalization, including time of ED arrival. PATIENTS AND METHODS: This was a retrospective cohort study of patients with cancer (excluding leukemia and nonmelanoma skin cancer) between 2012 and 2016 at a large county urban safety-net health system. We identified ED visits occurring within 180 days after a cancer diagnosis, along with subsequent hospitalizations (observation stay or inpatient admission). We used mixed-effects multivariable logistic regression to model hospitalization at ED disposition, accounting for variability across patients and emergency physicians. RESULTS: The 9,050 adults with cancer were 77.2% nonwhite and 55.0% female. Nearly one-quarter (24.7%) of patients had advanced-stage cancer at diagnosis, and 9.7% died within 180 days of diagnosis. These patients accrued 11,282 ED visits within 180 days of diagnosis. Most patients had at least one ED visit (57.7%); half (49.9%) occurred during business hours (Monday through Friday, 8:00 am to 4:59 pm), and half (50.4%) resulted in hospitalization. More than half (57.5%) of ED visits were for complaints that included: pain/headache, nausea/vomiting/dehydration, fever, swelling, shortness of breath/cough, and medication refill. Patients were most often discharged home when they arrived between 8:00 am and 11:59 am (adjusted odds ratio for hospitalization, 0.69; 95% CI, 0.56 to 0.84). CONCLUSION: ED visits are common among safety-net patients with newly diagnosed cancer, and hospitalizations may be influenced by nonclinical factors. The majority of ED visits made by adults with newly diagnosed cancer in a safety-net health system could potentially be routed to an alternate site of care, such as a cancer urgent care clinic.

show abstract

Section: Outcomes and Statistical Analysismentioning

confidence: 99%

Characteristics of Emergency Department Visits and Select Predictors of Hospitalization for Adults With Newly Diagnosed Cancer in a Safety-Net Health System

Hong

Sadeghi

Harvey

et al. 2019

JOP

View full text Add to dashboard Cite

show abstract

“…We have previously described why we selected these two countries and the general role observation services plays in both. 14…”

Section: Goals Of This Investigationmentioning

confidence: 99%

How the Availability of Observation Status Affects Emergency Physician Decisionmaking

Wright

Martin

Ahmed

et al. 2018

Annals of Emergency Medicine

Self Cite

View full text Add to dashboard Cite

show abstract

“…It seems likely that these observed trends in total and out-of-pocket spending for observation care will continue over time due to the current policy climate and hospital and provider practice patterns. 18,24 While it appears unlikely that spending for observation care will soon exceed that associated with short-stay hospitalization given the large differences between the two, the rapid However, we also found that total spending and out-ofpocket spending for observation care for the commercially insured has increased rapidly over time and at rates much…”

Section: Discussionmentioning

confidence: 55%

Rising Use Of Observation Care Among The Commercially Insured May Lead to Total And Out-Of-Pocket Cost Savings

et al. 2017

View full text Add to dashboard Cite

Proponents of hospital-based observation care argue that it has the potential to reduce health care spending and lengths-of-stay, compared to short-stay inpatient hospitalizations. However, critics have raised concerns about the out-of-pocket spending associated with observation care. Recent reports of high out-of-pocket spending among Medicare beneficiaries have received considerable media attention and have prompted direct policy changes. Despite the potential for changed policies to indirectly affect non-Medicare patients, little is known about the use of, and spending associated with, observation care among commercially insured populations. Using multipayer commercial claims for the period 2009-13, we evaluated utilization and spending among patients admitted for six conditions that are commonly managed with either observation care or short-stay hospitalizations. In our study period, the use of observation care increased relative to that of short-stay hospitalizations. Total and out-of-pocket spending were substantially lower for observation care, though both grew rapidly-and at rates much higher than spending in the inpatient setting-over the study period. Despite this growth, spending on observation care is unlikely to exceed spending for short-stay hospitalizations. As observation care attracts greater attention, policy makers should be aware that Medicare policies that disincentivize observation may have unintended financial impacts on non-Medicare populations, where observation care may be cost saving.

show abstract

Use or Abuse? A Qualitative Study of Emergency Physicians' Views on Use of Observation Stays at Three Hospitals in the United States and England

Cited by 12 publications

References 35 publications

Characteristics of Emergency Department Visits and Select Predictors of Hospitalization for Adults With Newly Diagnosed Cancer in a Safety-Net Health System

Characteristics of Emergency Department Visits and Select Predictors of Hospitalization for Adults With Newly Diagnosed Cancer in a Safety-Net Health System

How the Availability of Observation Status Affects Emergency Physician Decisionmaking

Rising Use Of Observation Care Among The Commercially Insured May Lead to Total And Out-Of-Pocket Cost Savings

Contact Info

Product

Resources

About