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Observation Status Stays With Low Resource Use Within Children's Hospitals.
Pediatrics. 2021 04; 147(4)Ped

Abstract

BACKGROUND

High costs associated with hospitalization have encouraged reductions in unnecessary encounters. A subset of observation status patients receive minimal interventions and incur low use costs. These patients may contain a cohort that could safely be treated outside of the hospital. Thus, we sought to describe characteristics of low resource use (LRU) observation status hospitalizations and variation in LRU stays across hospitals.

METHODS

We conducted a retrospective cohort study of pediatric observation encounters at 42 hospitals contributing to the Pediatric Health Information System database from January 1, 2019, to December 31, 2019. For each hospitalization, we calculated the use ratio (nonroom costs to total hospitalization cost). We grouped stays into use quartiles with the lowest labeled LRU. We described associations with LRU stays and performed classification and regression tree analyses to identify the combination of characteristics most associated with LRU. Finally, we described the proportion of LRU hospitalizations across hospitals.

RESULTS

We identified 174 315 observation encounters (44 422 LRU). Children <1 year (odds ratio [OR] 3.3; 95% confidence interval [CI] 3.1-3.4), without complex chronic conditions (OR 3.6; 95% CI 3.2-4.0), and those directly admitted (OR 4.2; 95% CI 4.1-4.4) had the greatest odds of experiencing an LRU encounter. Those children with the combination of direct admission, no medical complexity, and a respiratory diagnosis experienced an LRU stay 69.5% of the time. We observed variation in LRU encounters (1%-57% of observation encounters) across hospitals.

CONCLUSIONS

LRU observation encounters are variable across children's hospitals. These stays may include a cohort of patients who could be treated outside of the hospital.

Authors+Show Affiliations

Children's Mercy Hospital, Kansas City, Missouri; dcsynhorst@cmh.edu.Children's Mercy Hospital, Kansas City, Missouri. Children's Hospital Association, Lenexa, Kansas.Children's Mercy Hospital, Kansas City, Missouri.Children's Mercy Hospital, Kansas City, Missouri.Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois. Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, Illinois.Vanderbilt University Medical Center, Nashville, Tennessee; and.Nationwide Children's Hospital, Columbus, Ohio.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

33707196

Citation

Synhorst, David C., et al. "Observation Status Stays With Low Resource Use Within Children's Hospitals." Pediatrics, vol. 147, no. 4, 2021.
Synhorst DC, Hall M, Bettenhausen JL, et al. Observation Status Stays With Low Resource Use Within Children's Hospitals. Pediatrics. 2021;147(4).
Synhorst, D. C., Hall, M., Bettenhausen, J. L., Markham, J. L., Macy, M. L., Gay, J. C., & Morse, R. (2021). Observation Status Stays With Low Resource Use Within Children's Hospitals. Pediatrics, 147(4). https://doi.org/10.1542/peds.2020-013490
Synhorst DC, et al. Observation Status Stays With Low Resource Use Within Children's Hospitals. Pediatrics. 2021;147(4) PubMed PMID: 33707196.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Observation Status Stays With Low Resource Use Within Children's Hospitals. AU - Synhorst,David C, AU - Hall,Matthew, AU - Bettenhausen,Jessica L, AU - Markham,Jessica L, AU - Macy,Michelle L, AU - Gay,James C, AU - Morse,Rustin, Y1 - 2021/03/11/ PY - 2020/12/22/accepted PY - 2021/3/13/pubmed PY - 2021/8/5/medline PY - 2021/3/12/entrez JF - Pediatrics JO - Pediatrics VL - 147 IS - 4 N2 - BACKGROUND: High costs associated with hospitalization have encouraged reductions in unnecessary encounters. A subset of observation status patients receive minimal interventions and incur low use costs. These patients may contain a cohort that could safely be treated outside of the hospital. Thus, we sought to describe characteristics of low resource use (LRU) observation status hospitalizations and variation in LRU stays across hospitals. METHODS: We conducted a retrospective cohort study of pediatric observation encounters at 42 hospitals contributing to the Pediatric Health Information System database from January 1, 2019, to December 31, 2019. For each hospitalization, we calculated the use ratio (nonroom costs to total hospitalization cost). We grouped stays into use quartiles with the lowest labeled LRU. We described associations with LRU stays and performed classification and regression tree analyses to identify the combination of characteristics most associated with LRU. Finally, we described the proportion of LRU hospitalizations across hospitals. RESULTS: We identified 174 315 observation encounters (44 422 LRU). Children <1 year (odds ratio [OR] 3.3; 95% confidence interval [CI] 3.1-3.4), without complex chronic conditions (OR 3.6; 95% CI 3.2-4.0), and those directly admitted (OR 4.2; 95% CI 4.1-4.4) had the greatest odds of experiencing an LRU encounter. Those children with the combination of direct admission, no medical complexity, and a respiratory diagnosis experienced an LRU stay 69.5% of the time. We observed variation in LRU encounters (1%-57% of observation encounters) across hospitals. CONCLUSIONS: LRU observation encounters are variable across children's hospitals. These stays may include a cohort of patients who could be treated outside of the hospital. SN - 1098-4275 UR - https://www.unboundmedicine.com/medline/citation/33707196/Observation_Status_Stays_With_Low_Resource_Use_Within_Children's_Hospitals_ L2 - http://pediatrics.aappublications.org/cgi/pmidlookup?view=long&amp;pmid=33707196 DB - PRIME DP - Unbound Medicine ER -