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Hospital Observation Status and Readmission Rates.
Pediatrics. 2020 11; 146(5)Ped

Abstract

BACKGROUND

In several states, payers penalize hospitals when an inpatient readmission follows an inpatient stay. Observation stays are typically excluded from readmission calculations. Previous studies suggest inconsistent use of observation designations across hospitals. We sought to describe variation in observation stays and examine the impact of inclusion of observation stays on readmission metrics.

METHODS

We conducted a retrospective cohort study of hospitalizations at 50 hospitals contributing to the Pediatric Health Information System database from January 1, 2018, to December 31, 2018. We examined prevalence of observation use across hospitals and described changes to inpatient readmission rates with higher observation use. We described 30-day inpatient-only readmission rates and ranked hospitals against peer institutions. Finally, we included observation encounters into the calculation of readmission rates and evaluated hospitals' change in readmission ranking.

RESULTS

Most hospitals (n = 44; 88%) used observation status, with high variation in use across hospitals (0%-53%). Readmission rate after index inpatient stay (6.8%) was higher than readmission after an index observation stay (4.4%), and higher observation use by hospital was associated with higher inpatient-only readmission rates. When compared with peers, hospital readmission rank changed with observation inclusion (60% moving at least 1 quintile).

CONCLUSIONS

The use of observation status is variable among children's hospitals. Hospitals that more liberally apply observation status perform worse on the current inpatient-to-inpatient readmission metric, and inclusion of observation stays in the calculation of readmission rates significantly affected hospital performance compared with peer institutions. Consideration should be given to include all admission types for readmission rate calculation.

Authors+Show Affiliations

Department of Pediatrics, Children's Mercy Hospital and University of Missouri-Kansas City, Kansas City, Missouri; dcsynhorst@cmh.edu.Department of Pediatrics, Children's Mercy Hospital and University of Missouri-Kansas City, Kansas City, Missouri. Children's Hospital Association, Lenexa, Kansas.Children's Hospital Association, Lenexa, Kansas.Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee.Department of Population Medicine, Harvard Medical School, Harvard University and Harvard Pilgrim Health Care Institute, Boston, Massachusetts.Division of Hospital Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio. Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, Ohio.Department of Pediatrics, College of Medicine, Medical University of South Carolina, Charleston, South Carolina.Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois. Feinberg School of Medicine, Northwestern University, Chicago, Illinois.Division of Emergency Medicine, Department of Pediatrics, Boston Children's Hospital, Boston, Massachusetts.Division of Pediatric Emergency Medicine, Department of Pediatrics, School of Medicine, Emory University and Children's Healthcare of Atlanta, Atlanta, Georgia.Division of Hospital Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio. Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, Ohio.Division of Critical Care Medicine, Nationwide Children's Hospital, Columbus, Ohio.Section of Pediatric Cardiothoracic Surgery, Division of Cardiothoracic Surgery, Department of Surgery, School of Medicine, Washington University in St Louis and Heart Center, St Louis Children's Hospital, St Louis, Missouri.Division of Hospitalist Medicine, Children's National Hospital, Washington, District of Columbia; and.Children's Medical Center Dallas, Children's Health and University of Texas Southwestern Medical Center, Dallas, Texas.

Pub Type(s)

Journal Article
Multicenter Study
Research Support, U.S. Gov't, P.H.S.

Language

eng

PubMed ID

33067343

Citation

Synhorst, David C., et al. "Hospital Observation Status and Readmission Rates." Pediatrics, vol. 146, no. 5, 2020.
Synhorst DC, Hall M, Harris M, et al. Hospital Observation Status and Readmission Rates. Pediatrics. 2020;146(5).
Synhorst, D. C., Hall, M., Harris, M., Gay, J. C., Peltz, A., Auger, K. A., Teufel, R. J., Macy, M. L., Neuman, M. I., Simon, H. K., Shah, S. S., Lutmer, J., Eghtesady, P., Pavuluri, P., & Morse, R. B. (2020). Hospital Observation Status and Readmission Rates. Pediatrics, 146(5). https://doi.org/10.1542/peds.2020-003954
Synhorst DC, et al. Hospital Observation Status and Readmission Rates. Pediatrics. 2020;146(5) PubMed PMID: 33067343.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Hospital Observation Status and Readmission Rates. AU - Synhorst,David C, AU - Hall,Matt, AU - Harris,Mitch, AU - Gay,James C, AU - Peltz,Alon, AU - Auger,Katherine A, AU - Teufel,Ronald J,2nd AU - Macy,Michelle L, AU - Neuman,Mark I, AU - Simon,Harold K, AU - Shah,Samir S, AU - Lutmer,Jeffrey, AU - Eghtesady,Pirooz, AU - Pavuluri,Padmaja, AU - Morse,Rustin B, Y1 - 2020/10/16/ PY - 2020/08/19/accepted PY - 2020/10/18/pubmed PY - 2020/11/27/medline PY - 2020/10/17/entrez JF - Pediatrics JO - Pediatrics VL - 146 IS - 5 N2 - BACKGROUND: In several states, payers penalize hospitals when an inpatient readmission follows an inpatient stay. Observation stays are typically excluded from readmission calculations. Previous studies suggest inconsistent use of observation designations across hospitals. We sought to describe variation in observation stays and examine the impact of inclusion of observation stays on readmission metrics. METHODS: We conducted a retrospective cohort study of hospitalizations at 50 hospitals contributing to the Pediatric Health Information System database from January 1, 2018, to December 31, 2018. We examined prevalence of observation use across hospitals and described changes to inpatient readmission rates with higher observation use. We described 30-day inpatient-only readmission rates and ranked hospitals against peer institutions. Finally, we included observation encounters into the calculation of readmission rates and evaluated hospitals' change in readmission ranking. RESULTS: Most hospitals (n = 44; 88%) used observation status, with high variation in use across hospitals (0%-53%). Readmission rate after index inpatient stay (6.8%) was higher than readmission after an index observation stay (4.4%), and higher observation use by hospital was associated with higher inpatient-only readmission rates. When compared with peers, hospital readmission rank changed with observation inclusion (60% moving at least 1 quintile). CONCLUSIONS: The use of observation status is variable among children's hospitals. Hospitals that more liberally apply observation status perform worse on the current inpatient-to-inpatient readmission metric, and inclusion of observation stays in the calculation of readmission rates significantly affected hospital performance compared with peer institutions. Consideration should be given to include all admission types for readmission rate calculation. SN - 1098-4275 UR - https://www.unboundmedicine.com/medline/citation/33067343/Hospital_Observation_Status_and_Readmission_Rates_ L2 - http://pediatrics.aappublications.org/cgi/pmidlookup?view=long&pmid=33067343 DB - PRIME DP - Unbound Medicine ER -