Chest Pain Patients at Veterans Hospitals Are Increasingly More Likely to Be Observed Than Admitted for Short Stays

Brad Wright; Amy M J O'Shea; Justin M Glasgow; Padmaja Ayyagari; Mary Vaughan Sarrazin

doi:10.1177/0046958016666752

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Chest Pain Patients at Veterans Hospitals Are Increasingly More Likely to Be Observed Than Admitted for Short Stays

Journal article

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Chest Pain Patients at Veterans Hospitals Are Increasingly More Likely to Be Observed Than Admitted for Short Stays

Brad Wright, Amy M J O'Shea, Justin M Glasgow, Padmaja Ayyagari and Mary Vaughan Sarrazin

Inquiry (Chicago), Vol.53, p.4695801666675

2016

DOI: 10.1177/0046958016666752

PMCID: PMC5798678

PMID: 27637268

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Abstract

Observation stays are an outpatient service used to diagnose and treat patients for extended periods of time while a decision is made regarding inpatient admission or discharge. Although the use of observation stays is increasing, little is known about which patients are observed and which are admitted for similar periods of time as inpatients. The aim was to identify patient characteristics associated with being observed rather than admitted for a short stay (<48 hours) within the Veterans Health Administration (VHA). In our longitudinal analysis, we used logistic regression within a generalized estimating equation framework to model observation stays as a function of patient characteristics, time trends, and hospital fixed effects. To minimize heterogeneity between groups, we limit our sample to patients with a presenting diagnosis of chest pain. Our analysis includes a total of 121 584 hospital events, which consist of all observation and short-stay admissions for chest pain patients at VHA hospitals between 2005 and 2013. Both the absolute and relative use of observation stays increased markedly over time. The odds of an observation stay were higher among women, but lower among older patients and rural residents. Despite strong evidence that chest pain patients are increasingly more likely to be observed than admitted, suggesting a substitution effect, we find little evidence of within-hospital disparities in VHA observation stay use.

Decision Making

Demography

Chest Pain

Humans

Middle Aged

Patient Admission

Female

Logistic Models

Male

Watchful Waiting

Aged

Hospitals, Veterans

Details

Title: Subtitle: Chest Pain Patients at Veterans Hospitals Are Increasingly More Likely to Be Observed Than Admitted for Short Stays
Creators: Brad Wright - The University of Iowa, Iowa City, USA brad-wright@uiowa.edu
Amy M J O'Shea - The University of Iowa, Iowa City, USA The Comprehensive Access & Delivery Research and Evaluation Center, Iowa City Veterans Affairs Healthcare System, IA, USA
Justin M Glasgow - The Comprehensive Access & Delivery Research and Evaluation Center, Iowa City Veterans Affairs Healthcare System, IA, USA Christiana Care Health System, Wilmington, DE, USA
Padmaja Ayyagari - The University of Iowa, Iowa City, USA
Mary Vaughan Sarrazin - The University of Iowa, Iowa City, USA The Comprehensive Access & Delivery Research and Evaluation Center, Iowa City Veterans Affairs Healthcare System, IA, USA
Resource Type: Journal article
Publication Details: Inquiry (Chicago), Vol.53, p.4695801666675
DOI: 10.1177/0046958016666752
PMID: 27637268
PMCID: PMC5798678
NLM abbreviation: Inquiry
ISSN: 0046-9580
eISSN: 1945-7243
Publisher: United States
Language: English
Date published: 2016
Academic Unit: Health Management and Policy; Public Policy Center (Archive); General Internal Medicine; Internal Medicine
Record Identifier: 9984063132402771

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