Department of Emergency Medicine, University of Washington, Seattle, WA.
Department of Health Management and Policy, University of Iowa, Iowa City, IA.
Ann Emerg Med. 2019 Sep;74(3):334-344. doi: 10.1016/j.annemergmed.2018.10.002. Epub 2018 Nov 22.
Observation stays are composing an increasing proportion of unscheduled hospitalizations in the United States, with unclear consequences for the quality of care. This study used a nationally representative data set of commercially insured patients hospitalized from the emergency department (ED) to compare 30-day postdischarge unplanned care events after an observation stay versus a short inpatient admission.
This was a retrospective analysis of ED hospitalizations using the 2015 Truven MarketScan Commercial Claims and Encounters data set. Adult observation stays and short inpatient hospitalizations of 2 days or less were identified and followed for 30 days from hospital discharge to identify unplanned care events, defined as a subsequent inpatient admission, observation stay, or return ED visit. A propensity score analysis was used to compare rates of unplanned events after each type of index hospitalization.
Among the propensity-weighted cohorts, patients with an index observation stay were 28% more likely to experience any unplanned care event within 30 days of discharge compared with those with a short inpatient admission (20.4% versus 15.9%; risk ratio 1.28; 95% confidence interval [CI] 1.21 to 1.34). Specifically, patients in the observation stay group had substantially higher rates of postdischarge observation stays (4.8% versus 1.9%; odds ratio 2.60; 95% CI 2.15 to 3.16) and ED revisits with discharge (11.1% versus 8.8%; odds ratio 1.26; 95% CI 1.21 to 1.44) compared with those in the inpatient group, but were less likely to be readmitted as inpatients (6.4% versus 7.2%; odds ratio 0.90; 95% CI 0.83 to 0.96).
Commercially insured patients with an observation stay from the ED have a higher risk of postdischarge acute care events compared with similar patients with a short inpatient admission. Additional research is necessary to determine the extent to which quality of care, including care transitions, may differ between these 2 groups.
在美国，观察留观患者在非计划性住院患者中占比越来越大，但其对医疗质量的影响尚不清楚。本研究使用美国商业保险患者人群的全国代表性急诊（ED）住院数据集，比较观察留观与短期住院后 30 天内的非计划性出院后医疗事件。
本研究是对 2015 年 Truven MarketScan 商业索赔和就诊数据集的 ED 住院患者进行的回顾性分析。确定观察留观和住院时间为 2 天或更短的短期住院，并在出院后 30 天内随访，以确定非计划性医疗事件，包括随后的住院、观察留观或再次返回 ED 就诊。采用倾向评分分析比较两种类型的指数住院后非计划性事件的发生率。
在倾向评分加权队列中，与短期住院相比，指数观察留观患者在出院后 30 天内发生任何非计划性医疗事件的风险高 28%（20.4%比 15.9%；风险比 1.28；95%置信区间[CI]1.21 至 1.34）。具体而言，观察留观组患者出院后观察留观（4.8%比 1.9%；比值比 2.60；95%CI 2.15 至 3.16）和 ED 复诊（11.1%比 8.8%；比值比 1.26；95%CI 1.21 至 1.44）的比例显著高于住院组，而再次住院的比例（6.4%比 7.2%；比值比 0.90；95%CI 0.83 至 0.96）低于住院组。
与类似的短期住院患者相比，ED 观察留观患者出院后发生急性医疗事件的风险更高。需要进一步研究以确定这两组患者之间的医疗质量（包括医疗服务转接）差异程度。
