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Trends in observation-prone emergency department visits among Michigan children, 2007-2011.
Acad Emerg Med. 2015 Apr; 22(4):483-6.AE

Abstract

OBJECTIVES

To the best of the authors' knowledge, admission of children under observation status in community hospitals has not been examined. The hypothesis of this study was that there has been an increase in observation charge code use over time and variations in the application of observation charge codes across hospital types.

METHODS

This was a cross-sectional analysis of 5 years (2007 through 2011) of administrative claims data from Michigan residents enrolled in Medicaid, Blue Cross/Blue Shield of Michigan preferred provider organization, and Blue Cross Network health maintenance organization compiled into a single data set. Emergency department (ED) visits to facilities in Michigan made by children (younger than 18 years) were selected. Observation-prone ED visits were identified based on the presence of International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes. Counts of observation-prone ED visits were determined and descriptive statistics were calculated. Changes over time in the proportion of visits with observation charge codes by hospital type were assessed with chi-square analysis.

RESULTS

The observation-prone ICD-9-CM codes were identified in 881,622 ED visits made by children to 142 Michigan facilities during the 5-year study period. Overall, the vast majority of visits (n = 646,499; 91.0%) with the selected ICD-9-CM codes resulted in discharge from the ED without associated observation or inpatient charge codes. Among the 64,288 visits that resulted in admission for observation or inpatient care, observation charge codes without inpatient charge codes were applied to 22,933 (35.7%) admissions, observation and inpatient charge codes were applied to 4,756 (7.4%) admissions, and inpatient charge codes without observation charge codes were applied to 36,599 (56.9%) admissions. Hospitals with pediatric ED and inpatient services (Type 1 and Type 2 hospitals) had higher proportions of ED visits that went on to admission for observation or inpatient care (15.9 and 10.7%) than hospitals without pediatric ED services (Type 3 and Type 4 hospitals; 7.2 and 3.7%). The proportion of admissions that had observation charge codes for all hospital types increased over time, most prominently among Type 1 and Type 2 hospitals.

CONCLUSIONS

The application of observation charge codes to Michigan children with observation-prone conditions has increased over time across all hospital types. There is a need to evaluate pediatric observation care in diverse settings to compare the effectiveness of different models.

Authors+Show Affiliations

The Department of Emergency Medicine, Children's Emergency Services, Ann Arbor, MI; Child Health Evaluation and Research (CHEAR) Unit, Division of General Pediatrics, University of Michigan, Ann Arbor, MI.No affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

25773604

Citation

Macy, Michelle L., et al. "Trends in Observation-prone Emergency Department Visits Among Michigan Children, 2007-2011." Academic Emergency Medicine : Official Journal of the Society for Academic Emergency Medicine, vol. 22, no. 4, 2015, pp. 483-6.
Macy ML, Cohn L, Clark SJ. Trends in observation-prone emergency department visits among Michigan children, 2007-2011. Acad Emerg Med. 2015;22(4):483-6.
Macy, M. L., Cohn, L., & Clark, S. J. (2015). Trends in observation-prone emergency department visits among Michigan children, 2007-2011. Academic Emergency Medicine : Official Journal of the Society for Academic Emergency Medicine, 22(4), 483-6. https://doi.org/10.1111/acem.12624
Macy ML, Cohn L, Clark SJ. Trends in Observation-prone Emergency Department Visits Among Michigan Children, 2007-2011. Acad Emerg Med. 2015;22(4):483-6. PubMed PMID: 25773604.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Trends in observation-prone emergency department visits among Michigan children, 2007-2011. AU - Macy,Michelle L, AU - Cohn,Lisa, AU - Clark,Sarah J, Y1 - 2015/03/13/ PY - 2014/08/14/received PY - 2014/10/16/revised PY - 2014/10/17/accepted PY - 2015/3/17/entrez PY - 2015/3/17/pubmed PY - 2015/11/3/medline SP - 483 EP - 6 JF - Academic emergency medicine : official journal of the Society for Academic Emergency Medicine JO - Acad Emerg Med VL - 22 IS - 4 N2 - OBJECTIVES: To the best of the authors' knowledge, admission of children under observation status in community hospitals has not been examined. The hypothesis of this study was that there has been an increase in observation charge code use over time and variations in the application of observation charge codes across hospital types. METHODS: This was a cross-sectional analysis of 5 years (2007 through 2011) of administrative claims data from Michigan residents enrolled in Medicaid, Blue Cross/Blue Shield of Michigan preferred provider organization, and Blue Cross Network health maintenance organization compiled into a single data set. Emergency department (ED) visits to facilities in Michigan made by children (younger than 18 years) were selected. Observation-prone ED visits were identified based on the presence of International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes. Counts of observation-prone ED visits were determined and descriptive statistics were calculated. Changes over time in the proportion of visits with observation charge codes by hospital type were assessed with chi-square analysis. RESULTS: The observation-prone ICD-9-CM codes were identified in 881,622 ED visits made by children to 142 Michigan facilities during the 5-year study period. Overall, the vast majority of visits (n = 646,499; 91.0%) with the selected ICD-9-CM codes resulted in discharge from the ED without associated observation or inpatient charge codes. Among the 64,288 visits that resulted in admission for observation or inpatient care, observation charge codes without inpatient charge codes were applied to 22,933 (35.7%) admissions, observation and inpatient charge codes were applied to 4,756 (7.4%) admissions, and inpatient charge codes without observation charge codes were applied to 36,599 (56.9%) admissions. Hospitals with pediatric ED and inpatient services (Type 1 and Type 2 hospitals) had higher proportions of ED visits that went on to admission for observation or inpatient care (15.9 and 10.7%) than hospitals without pediatric ED services (Type 3 and Type 4 hospitals; 7.2 and 3.7%). The proportion of admissions that had observation charge codes for all hospital types increased over time, most prominently among Type 1 and Type 2 hospitals. CONCLUSIONS: The application of observation charge codes to Michigan children with observation-prone conditions has increased over time across all hospital types. There is a need to evaluate pediatric observation care in diverse settings to compare the effectiveness of different models. SN - 1553-2712 UR - https://www.unboundmedicine.com/medline/citation/25773604/Trends_in_observation_prone_emergency_department_visits_among_Michigan_children_2007_2011_ L2 - https://doi.org/10.1111/acem.12624 DB - PRIME DP - Unbound Medicine ER -