TY - JOUR
T1 - Racial and ethnic disparities in hospital observation in Maryland
AU - Cichowitz, Cody
AU - Loevinsohn, Gideon
AU - Klein, Eili Y.
AU - Colantuoni, Elizabeth
AU - Galiatsatos, Panagis
AU - Rennert, Jodi
AU - Irvin, Nathan A.
N1 - Funding Information:
All authors were involved the drafting and editing of the manuscript. CC and GL constructed the statistical models and performed the analysis. EK facilitated access to the data. EC and EK advised on statistical analysis. NI, JR, PG, and EK provided input on study questions and significance.
Publisher Copyright:
© 2020 Elsevier Inc.
PY - 2021/8
Y1 - 2021/8
N2 - Objectives: Hospital observation is a key disposition option from the emergency department (ED) and encompasses up to one third of patients requiring post-ED care. Observation has been associated with higher incidence of catastrophic financial costs and has downstream effects on post-discharge clinical services. Yet little is known about the non-clinical determinants of observation assignment. We sought to evaluate the impact of patient-level demographic factors on observation designation among Maryland patients. Methods: We conducted a retrospective analysis of all ED encounters in Maryland between July 2012 and January 2017 for four priority diagnoses (heart failure, chronic obstructive pulmonary disease [COPD], pneumonia, and acute chest pain) using multilevel logistic models allowing for heterogeneity of the effects across hospitals. The primary exposure was self-reported race and ethnicity. The primary outcome was the initial status assignment from the ED: hospital observation versus inpatient admission. Results: Across 46 Maryland hospitals, 259,788 patient encounters resulted in a disposition of inpatient admission (65%) or observation designation (35%). Black (adjusted odds ratio [aOR]: 1.19; 95% confidence interval [CI]: 1.16–1.23) and Hispanic (aOR: 1.11; 95% CI: 1.01–1.21) patients were significantly more likely to be placed in observation than white, non-Hispanic patients. These differences were consistent across the majority of acute-care hospitals in Maryland (27/46). Conclusion: Black and Hispanic patients in Maryland are more likely to be treated under the observation designation than white, non-Hispanic patients independent of clinical presentation. Race agnostic, time-based status assignments may be key in eliminating these disparities.
AB - Objectives: Hospital observation is a key disposition option from the emergency department (ED) and encompasses up to one third of patients requiring post-ED care. Observation has been associated with higher incidence of catastrophic financial costs and has downstream effects on post-discharge clinical services. Yet little is known about the non-clinical determinants of observation assignment. We sought to evaluate the impact of patient-level demographic factors on observation designation among Maryland patients. Methods: We conducted a retrospective analysis of all ED encounters in Maryland between July 2012 and January 2017 for four priority diagnoses (heart failure, chronic obstructive pulmonary disease [COPD], pneumonia, and acute chest pain) using multilevel logistic models allowing for heterogeneity of the effects across hospitals. The primary exposure was self-reported race and ethnicity. The primary outcome was the initial status assignment from the ED: hospital observation versus inpatient admission. Results: Across 46 Maryland hospitals, 259,788 patient encounters resulted in a disposition of inpatient admission (65%) or observation designation (35%). Black (adjusted odds ratio [aOR]: 1.19; 95% confidence interval [CI]: 1.16–1.23) and Hispanic (aOR: 1.11; 95% CI: 1.01–1.21) patients were significantly more likely to be placed in observation than white, non-Hispanic patients. These differences were consistent across the majority of acute-care hospitals in Maryland (27/46). Conclusion: Black and Hispanic patients in Maryland are more likely to be treated under the observation designation than white, non-Hispanic patients independent of clinical presentation. Race agnostic, time-based status assignments may be key in eliminating these disparities.
KW - Disparities
KW - Equity
KW - Hospital observation
KW - Patient disposition
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U2 - 10.1016/j.ajem.2020.11.010
DO - 10.1016/j.ajem.2020.11.010
M3 - Article
C2 - 33243537
AN - SCOPUS:85097069564
SN - 0735-6757
VL - 46
SP - 532
EP - 538
JO - American Journal of Emergency Medicine
JF - American Journal of Emergency Medicine
ER -