Variation in the Use of Observation Status Evaluation in Massachusetts Acute Care Hospitals, 2003-2006

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Variation in the Use of Observation Status Evaluation in Massachusetts Acute Care Hospitals, 2003-2006

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dc.contributor.author Schuur, Jeremiah D
dc.contributor.author Venkatesh, Arjun
dc.contributor.author Bohan, John Stephen
dc.date.accessioned 2011-10-20T02:32:14Z
dc.date.issued 2010
dc.identifier.citation Schuur, Jeremiah D., Arjun K. Venkatesh, and J. Stephen Bohan. 2010. Variation in the use of observation status evaluation in Massachusetts acute care hospitals, 2003-2006. International Journal of Emergency Medicine 3(4): 367-372. en_US
dc.identifier.issn 1865-1372 en_US
dc.identifier.uri http://nrs.harvard.edu/urn-3:HUL.InstRepos:5266848
dc.description.abstract Background Observation evaluation is an alternate pathway to inpatient admission following Emergency Department (ED) assessment. Aims We aimed to describe the variation in observation use and charges between acute care hospitals in Massachusetts from 2003 to 2006. Methods Retrospective pilot analysis of hospital administrative data. Patients discharged from a Massachusetts hospital between 2003 and 2006 after an observation visit or inpatient hospitalization for six emergency medical conditions, grouped by the Clinical Classification System (CCS), were included. Patients discharged with a primary obstetric condition were excluded. The primary outcome measure, “Observation Proportion” (pOBS), was the use of observation evaluation relative to inpatient evaluation (pOBS = n Observation/(n Observation + n Inpatient). We calculated pOBS, descriptive statistics of use and charges by the hospital for each condition. Results From 2003 to 2006 the number of observation visits in Massachusetts increased 3.9% [95% confidence interval (CI) 3.8% to 4.0%] from 128,825 to 133,859, while inpatient hospitalization increased 1.29% (95% CI 1.26% to 1.31%) from 832,415 to 843,617. Nonspecific chest pain (CCS 102) was the most frequently observed condition with 85,843 (16.3% of total) observation evaluations. Observation visits for nonspecific chest pain increased 43.5% from 2003 to 2006. Relative observation utilization (pOBS) for nonspecific chest pain ranged from 25% to 95% across hospitals. Wide variation in hospital use of observation and charges was seen for all six emergency medical conditions. Conclusions There was wide variation in use of observation across six common emergency conditions in Massachusetts in this pilot analysis. This variation may have a substantial impact on hospital resource utilization. Further investigation into the patient, provider and hospital-level characteristics that explain the variation in observation use could help improve hospital efficiency. en_US
dc.language.iso en_US en_US
dc.publisher Springer-Verlag en_US
dc.relation.isversionof doi://10.1007/s12245-010-0188-6 en_US
dc.relation.hasversion http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3047847/pdf/ en_US
dash.license LAA
dc.subject emergency service en_US
dc.subject hospital en_US
dc.subject small-area analysis en_US
dc.subject hospital charges en_US
dc.subject chest pain en_US
dc.title Variation in the Use of Observation Status Evaluation in Massachusetts Acute Care Hospitals, 2003-2006 en_US
dc.type Journal Article en_US
dc.description.version Version of Record en_US
dc.relation.journal International Journal of Emergency Medicine en_US
dash.depositing.author Bohan, John Stephen
dc.date.available 2011-10-20T02:32:14Z
dash.affiliation.other HMS^Medicine-Brigham and Women's Hospital en_US

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