Outcomes after observation stays among older adult Medicare beneficiaries in the USA: Retrospective cohort study

Kumar Dharmarajan, Li Qin, Maggie Bierlein, Jennie Choe, Zhenqiu Lin, Nihar R. Desai, Erica S. Spatz, Harlan M. Krumholz, Arjun K. Venkatesh

Research output: Contribution to journalArticle

Abstract

Objective To characterize rates and trends over time of emergency department treatment-and-discharge stays, repeat observation stays, inpatient stays, any hospital revisit, and death within 30 days of discharge from observation stays. Design Retrospective cohort study. Setting 4750 hospitals in the USA. Participants Nationally representative sample of Medicare fee for service beneficiaries aged 65 or over discharged after 363 037 index observation stays, 2 540 000 index emergency department treatment-and-discharge stays, and 2 667 525 index inpatient stays from 2006-11. Main outcome measures Rates of emergency department treatment-and-discharge stays, observation stays, inpatient stays, any hospital revisit, and death within 30 days of discharge from index observation stays. Rates were compared with corresponding outcomes within 30 days of discharge from both index emergency department treatment-and-discharge stays and index inpatient stays. Results Among 363 037 index observation stays resulting in discharge from 2006-11, 30 day rates of emergency department treatment-and-discharge stays were 8.4%, repeat observation stays were 2.9%, inpatient stays were 11.2%, any hospital revisit was 20.1%, and death was 1.8%. Of all revisits, 49.7% were for inpatient stays. Revisit rates for emergency department treatment-and-discharge stays, repeat observation stays, and any hospital revisit increased from 2006-11 (P<0.001 for trend), while 30 day rates of inpatient stays (P=0.054 for trend) and 30 day mortality (P=0.091 for trend) were both unchanged. Averaged over the study period, 30 day rates of any hospital revisit were similar after discharge from index emergency department treatment-and-discharge stays (19.9%) and index observation stays (20.1%), as was 30 day mortality (1.8% for both). Rates of any hospital revisit (21.8%) and death (5.2%) were highest after discharge from index inpatient stays. Conclusions Hospital revisits are common after discharge from observation stays, frequently result in inpatient hospitalizations, and have increased over time among Medicare beneficiaries. As revisit rates are similar after emergency department and observation stays, strategies shown to enhance emergency department transitional care may be reasonable starting points to improve post-observation outcomes.

Original languageEnglish (US)
Article numberj2616
JournalBMJ (Online)
Volume357
DOIs
StatePublished - Jan 1 2017
Externally publishedYes

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Medicare
Cohort Studies
Retrospective Studies
Observation
Emergency Treatment
Hospital Emergency Service
Inpatients
Length of Stay
Fee-for-Service Plans
Mortality
Hospitalization
Outcome Assessment (Health Care)

ASJC Scopus subject areas

  • Medicine(all)

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Dharmarajan, K., Qin, L., Bierlein, M., Choe, J., Lin, Z., Desai, N. R., ... Venkatesh, A. K. (2017). Outcomes after observation stays among older adult Medicare beneficiaries in the USA: Retrospective cohort study. BMJ (Online), 357, [j2616]. https://doi.org/10.1136/bmj.j2616

Outcomes after observation stays among older adult Medicare beneficiaries in the USA : Retrospective cohort study. / Dharmarajan, Kumar; Qin, Li; Bierlein, Maggie; Choe, Jennie; Lin, Zhenqiu; Desai, Nihar R.; Spatz, Erica S.; Krumholz, Harlan M.; Venkatesh, Arjun K.

In: BMJ (Online), Vol. 357, j2616, 01.01.2017.

Research output: Contribution to journalArticle

Dharmarajan, K, Qin, L, Bierlein, M, Choe, J, Lin, Z, Desai, NR, Spatz, ES, Krumholz, HM & Venkatesh, AK 2017, 'Outcomes after observation stays among older adult Medicare beneficiaries in the USA: Retrospective cohort study', BMJ (Online), vol. 357, j2616. https://doi.org/10.1136/bmj.j2616
Dharmarajan, Kumar ; Qin, Li ; Bierlein, Maggie ; Choe, Jennie ; Lin, Zhenqiu ; Desai, Nihar R. ; Spatz, Erica S. ; Krumholz, Harlan M. ; Venkatesh, Arjun K. / Outcomes after observation stays among older adult Medicare beneficiaries in the USA : Retrospective cohort study. In: BMJ (Online). 2017 ; Vol. 357.
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title = "Outcomes after observation stays among older adult Medicare beneficiaries in the USA: Retrospective cohort study",
abstract = "Objective To characterize rates and trends over time of emergency department treatment-and-discharge stays, repeat observation stays, inpatient stays, any hospital revisit, and death within 30 days of discharge from observation stays. Design Retrospective cohort study. Setting 4750 hospitals in the USA. Participants Nationally representative sample of Medicare fee for service beneficiaries aged 65 or over discharged after 363 037 index observation stays, 2 540 000 index emergency department treatment-and-discharge stays, and 2 667 525 index inpatient stays from 2006-11. Main outcome measures Rates of emergency department treatment-and-discharge stays, observation stays, inpatient stays, any hospital revisit, and death within 30 days of discharge from index observation stays. Rates were compared with corresponding outcomes within 30 days of discharge from both index emergency department treatment-and-discharge stays and index inpatient stays. Results Among 363 037 index observation stays resulting in discharge from 2006-11, 30 day rates of emergency department treatment-and-discharge stays were 8.4{\%}, repeat observation stays were 2.9{\%}, inpatient stays were 11.2{\%}, any hospital revisit was 20.1{\%}, and death was 1.8{\%}. Of all revisits, 49.7{\%} were for inpatient stays. Revisit rates for emergency department treatment-and-discharge stays, repeat observation stays, and any hospital revisit increased from 2006-11 (P<0.001 for trend), while 30 day rates of inpatient stays (P=0.054 for trend) and 30 day mortality (P=0.091 for trend) were both unchanged. Averaged over the study period, 30 day rates of any hospital revisit were similar after discharge from index emergency department treatment-and-discharge stays (19.9{\%}) and index observation stays (20.1{\%}), as was 30 day mortality (1.8{\%} for both). Rates of any hospital revisit (21.8{\%}) and death (5.2{\%}) were highest after discharge from index inpatient stays. Conclusions Hospital revisits are common after discharge from observation stays, frequently result in inpatient hospitalizations, and have increased over time among Medicare beneficiaries. As revisit rates are similar after emergency department and observation stays, strategies shown to enhance emergency department transitional care may be reasonable starting points to improve post-observation outcomes.",
author = "Kumar Dharmarajan and Li Qin and Maggie Bierlein and Jennie Choe and Zhenqiu Lin and Desai, {Nihar R.} and Spatz, {Erica S.} and Krumholz, {Harlan M.} and Venkatesh, {Arjun K.}",
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T2 - Retrospective cohort study

AU - Dharmarajan, Kumar

AU - Qin, Li

AU - Bierlein, Maggie

AU - Choe, Jennie

AU - Lin, Zhenqiu

AU - Desai, Nihar R.

AU - Spatz, Erica S.

AU - Krumholz, Harlan M.

AU - Venkatesh, Arjun K.

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N2 - Objective To characterize rates and trends over time of emergency department treatment-and-discharge stays, repeat observation stays, inpatient stays, any hospital revisit, and death within 30 days of discharge from observation stays. Design Retrospective cohort study. Setting 4750 hospitals in the USA. Participants Nationally representative sample of Medicare fee for service beneficiaries aged 65 or over discharged after 363 037 index observation stays, 2 540 000 index emergency department treatment-and-discharge stays, and 2 667 525 index inpatient stays from 2006-11. Main outcome measures Rates of emergency department treatment-and-discharge stays, observation stays, inpatient stays, any hospital revisit, and death within 30 days of discharge from index observation stays. Rates were compared with corresponding outcomes within 30 days of discharge from both index emergency department treatment-and-discharge stays and index inpatient stays. Results Among 363 037 index observation stays resulting in discharge from 2006-11, 30 day rates of emergency department treatment-and-discharge stays were 8.4%, repeat observation stays were 2.9%, inpatient stays were 11.2%, any hospital revisit was 20.1%, and death was 1.8%. Of all revisits, 49.7% were for inpatient stays. Revisit rates for emergency department treatment-and-discharge stays, repeat observation stays, and any hospital revisit increased from 2006-11 (P<0.001 for trend), while 30 day rates of inpatient stays (P=0.054 for trend) and 30 day mortality (P=0.091 for trend) were both unchanged. Averaged over the study period, 30 day rates of any hospital revisit were similar after discharge from index emergency department treatment-and-discharge stays (19.9%) and index observation stays (20.1%), as was 30 day mortality (1.8% for both). Rates of any hospital revisit (21.8%) and death (5.2%) were highest after discharge from index inpatient stays. Conclusions Hospital revisits are common after discharge from observation stays, frequently result in inpatient hospitalizations, and have increased over time among Medicare beneficiaries. As revisit rates are similar after emergency department and observation stays, strategies shown to enhance emergency department transitional care may be reasonable starting points to improve post-observation outcomes.

AB - Objective To characterize rates and trends over time of emergency department treatment-and-discharge stays, repeat observation stays, inpatient stays, any hospital revisit, and death within 30 days of discharge from observation stays. Design Retrospective cohort study. Setting 4750 hospitals in the USA. Participants Nationally representative sample of Medicare fee for service beneficiaries aged 65 or over discharged after 363 037 index observation stays, 2 540 000 index emergency department treatment-and-discharge stays, and 2 667 525 index inpatient stays from 2006-11. Main outcome measures Rates of emergency department treatment-and-discharge stays, observation stays, inpatient stays, any hospital revisit, and death within 30 days of discharge from index observation stays. Rates were compared with corresponding outcomes within 30 days of discharge from both index emergency department treatment-and-discharge stays and index inpatient stays. Results Among 363 037 index observation stays resulting in discharge from 2006-11, 30 day rates of emergency department treatment-and-discharge stays were 8.4%, repeat observation stays were 2.9%, inpatient stays were 11.2%, any hospital revisit was 20.1%, and death was 1.8%. Of all revisits, 49.7% were for inpatient stays. Revisit rates for emergency department treatment-and-discharge stays, repeat observation stays, and any hospital revisit increased from 2006-11 (P<0.001 for trend), while 30 day rates of inpatient stays (P=0.054 for trend) and 30 day mortality (P=0.091 for trend) were both unchanged. Averaged over the study period, 30 day rates of any hospital revisit were similar after discharge from index emergency department treatment-and-discharge stays (19.9%) and index observation stays (20.1%), as was 30 day mortality (1.8% for both). Rates of any hospital revisit (21.8%) and death (5.2%) were highest after discharge from index inpatient stays. Conclusions Hospital revisits are common after discharge from observation stays, frequently result in inpatient hospitalizations, and have increased over time among Medicare beneficiaries. As revisit rates are similar after emergency department and observation stays, strategies shown to enhance emergency department transitional care may be reasonable starting points to improve post-observation outcomes.

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