Who Has an Unsuccessful Observation Care Stay?
Gelareh Z Gabayan1, Brian Doyle2, Li-Jung Liang3
1Department of Emergency Medicine, University of California, Los Angeles, CA 90024, USA. Gelareh@gabayan.com.
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.
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