Surgical Outcomes Quality Improvement Center, Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois.
Children's Hospital Association, Lenexa, Kansas.
J Hosp Med. 2021 Nov;16(11):645-651. doi: 10.12788/jhm.3622.
Observation status could improve efficiency of healthcare resource use but also might shift financial burdens to patients and hospitals. Although the use of observation stays has increased for adult patient populations, the trends are unknown among hospitalized children.
The goal of this study was to describe recent trends in observation stays for pediatric populations at children's hospitals.
DESIGN, SETTING, AND PARTICIPANTS: Both observation and inpatient stays for all conditions were retrospectively studied using the Pediatric Health Information System database (2010 to 2019).
EXPOSURE, MAIN OUTCOMES, AND MEASURES: Patient type was classified as inpatient or observation status. Main outcomes included annual percentage of observation stays, annual percentage of observation stays having prolonged length of stay (>2 days), and growth rates of observation stays for the 20 most common conditions. Risk adjusted hospital-level use of observation stays was estimated using generalized linear mixed-effects models.
The percentage of observation stays increased from 23.6% in 2010 to 34.3% in 2019 (P < .001), and the percentage of observation stays with prolonged length of stay rose from 1.1% to 4.6% (P < .001). Observation status was expanded among a diverse group of clinical conditions; diabetes mellitus and surgical procedures showed the highest growth rates. Adjusted hospital-level use ranged from 0% to 67% in 2019, indicating considerable variation among hospitals.
Based on the increase in observation stays, future studies should explore the appropriateness of observation care related to efficient use of healthcare resources and financial implications for hospitals and patients.
观察状态可以提高医疗资源使用效率，但也可能将财务负担转移给患者和医院。尽管成人患者群体的观察住院人数有所增加，但住院儿童的趋势尚不清楚。
本研究旨在描述儿童医院儿科人群观察住院的近期趋势。
设计、地点和参与者：使用儿科健康信息系统数据库（2010 年至 2019 年）回顾性研究所有疾病的观察和住院患者。
暴露、主要结果和措施：患者类型分为住院或观察状态。主要结果包括观察住院的年百分比、观察住院中延长住院时间（>2 天）的年百分比以及 20 种最常见疾病的观察住院增长率。使用广义线性混合效应模型估计观察住院的风险调整医院使用情况。
观察住院的比例从 2010 年的 23.6%增加到 2019 年的 34.3%（P<0.001），观察住院中延长住院时间的比例从 1.1%增加到 4.6%（P<0.001）。观察状态在各种临床疾病中得到扩展；糖尿病和手术显示出最高的增长率。2019 年调整后的医院使用比例在 0%至 67%之间，表明医院之间存在相当大的差异。
基于观察住院人数的增加，未来的研究应该探讨观察护理与医疗资源有效利用和医院及患者经济影响相关的适宜性。
