Journal article
Evidence of Racial and Geographic Disparities in the Use of Medicare Observation Stays and Subsequent Patient Outcomes Relative to Short-Stay Hospitalizations
Health equity, Vol.2(1), pp.45-54
01/01/2018
DOI: 10.1089/heq.2017.0055
PMCID: PMC6071902
PMID: 30272046
Abstract
Purpose: To examine racial and geographic disparities in the use of-and outcomes associated with-Medicare observation stays versus short-stay hospitalizations. Methods: We used 2007-2010 fee-for-service Medicare claims, including 3,555,994 observation and short-stay hospitalizations for individuals over age 65. We estimated linear probability models with hospital fixed effects to identify within-facility disparities in observation stay use, estimated in-hospital mortality, 30- and 90-day postdischarge mortality, return emergency department (ED) visits, and hospital readmissions as a function of placement in observation using linear probability models, propensity-score matching, and interaction terms. Results: We identified racial and geographic disparities in the likelihood of observation stay use within hospitals (blacks 3.9% points more likely than whites, rural 5.4% points less likely than urban). Observation is associated with an increased likelihood of returning to the ED within 30 or 90 days and a decreased likelihood of readmission or mortality, but there are racial and geographic disparities in these outcomes. Conclusion: While observation generally results in improved outcomes, disparities in these outcomes and the use of observation stays within hospitals are concerning and may be driven by clinical and nonclinical factors.
Details
- Title: Subtitle
- Evidence of Racial and Geographic Disparities in the Use of Medicare Observation Stays and Subsequent Patient Outcomes Relative to Short-Stay Hospitalizations
- Creators
- Brad Wright - University of IowaXuan Zhang - Brown UniversityMomotazur Rahman - Brown UniversityMahshid Abir - University of MichiganPadmaja Ayyagari - University of IowaKeith E. Kocher - University of Michigan
- Resource Type
- Journal article
- Publication Details
- Health equity, Vol.2(1), pp.45-54
- DOI
- 10.1089/heq.2017.0055
- PMID
- 30272046
- PMCID
- PMC6071902
- NLM abbreviation
- Health Equity
- ISSN
- 2473-1242
- eISSN
- 2473-1242
- Publisher
- Mary Ann Liebert, Inc
- Number of pages
- 10
- Language
- English
- Date published
- 01/01/2018
- Academic Unit
- Health Management and Policy; Public Policy Center (Archive)
- Record Identifier
- 9984364395702771
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