ArticleThe western journal of emergency medicine2015
Variability in the initial costs of care and one-year outcomes of observation services.
Article in The western journal of emergency medicine, 2015. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.
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Who cites it
2 citing papers in PubMed.
- A method for analyzing inpatient care variability through physicians' orders.Journal of biomedical informatics · 2019Article
- Outcomes after observation stays among older adult Medicare beneficiaries in the USA: retrospective cohort study.BMJ (Clinical research ed.) · 2017Article
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Authors and funding
1 author.
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No grant is acknowledged in the PubMed record.
Abstract
introductionThe use of observation units (OUs) following emergency departments (ED) visits as a model of care has increased exponentially in the last decade. About one-third of U.S. hospitals now have OUs within their facilities. While their use is associated with lower costs and comparable level of care compared to inpatient units, there is a wide variation in OUs characteristics and operational procedures. The objective of this research was to explore the variability in the initial costs of care of placing patients with non-specific chest pain in observation units (OUs) and the one-year outcomes.
methodsThe author retrospectively investigated medical insurance claims of 22,962 privately insured patients (2009-2011) admitted to 41 OUs. Outcomes included the one-year chest pain/cardiovascular related costs and primary and secondary outcomes. Primary outcomes included myocardial infarction, congestive heart failure, stroke or cardiac arrest, while secondary outcomes included revascularization procedures, ED revisits for angina pectoris or chest pain and hospitalization due to cardiovascular diseases. The author aggregated the adjusted costs and prevalence rates of outcomes for patients over OUs, and computed the weighted coefficients of variation (WCV) to compare variations across OUs.
resultsThere was minimal variability in the initial costs of care (WCV=2.2%), while the author noticed greater variability in the outcomes. Greater variability were associated with the adjusted cardiovascular-related costs of medical services (WCV=17.6%) followed by the adjusted prevalence odds ratio of patients experiencing primary outcomes (WCV=16.3%) and secondary outcomes (WCV=10%).
conclusionHigher variability in the outcomes suggests the need for more standardization of the observation services for chest pain patients.
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