ArticleMayo Clinic proceedings2020
Thirty-Day Re-observation, Chronic Re-observation, and Neighborhood Disadvantage.
Article in Mayo Clinic proceedings, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 31 papers, 1 of them a synthesis that pooled it.
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The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
31 citing papers in PubMed, 1 synthesis or guideline pooled it, 46 citations in OpenAlex.
- Area-Level Socioeconomic Disadvantage and Health Care Spending: A Systematic Review.JAMA network open · 2024Pooled it
- Efficacy of everolimus and letrozole with or without ribociclib in recurrent endometrial cancer: a phase 2 randomized clinical trial.Nature communications · 2026Trial
- Precision greenness exposure is associated with lung cancer risk in medicare beneficiaries.Cancer causes & control : CCC · 2026Article
- Outcomes following intradetrusor onabotulinumtoxinA injections and sacral neuromodulation in older men.BJUI compass · 2026Article
- Article
- Integrating multiple data sources to predict all-cause readmission or mortality in patients with substance misuse.PLOS digital health · 2025Article
- Neighborhood matters: An exploration of neighborhood-level disadvantage and cancer preventive behaviors in Hispanic youth with unhealthy weight.Health & place · 2025Article
- Year 1 of Medicare's Accountable Care Organization Realizing Equity, Access, and Community Health Model.JAMA health forum · 2025Article
- Socioeconomic Characteristics of Communities With Primary Care Practices With Nurse Practitioners.JAMA network open · 2025Article
- Social Determinants of Health: The Impact of This Overlooked Vital Sign.Journal of Brown hospital medicine · 2025Review
- Sacral neuromodulation in nursing home residents: Predictors of success and complications in a national cohort of older adults.Neurourology and urodynamics · 2024Article
- The Effect of Social Deprivation on Hospital Utilization Following Distal Radius Fracture Treatment.Journal of hand surgery global online · 2024Article
- Trends in observation stays for Medicare beneficiaries with and without Alzheimer's disease and related dementias.Journal of the American Geriatrics Society · 2024Article
- Examining rehabilitation access disparities: an integrated analysis of electronic health record data and population characteristics through bivariate choropleth mapping.BMC health services research · 2024Article
- The role of place-based factors and other social determinants of health on adverse post-sepsis outcomes: a review of the literature.Frontiers in disaster and emergency medicine · 2024Article
- Associations between health insurance status, neighborhood deprivation, and treatment delays in women with breast cancer living in Georgia.Cancer medicine · 2023Article
- Health care policy that relies on poor measurement is ineffective: Lessons from the hospital readmissions reduction program.Health services research · 2023Article
- Critical interactions between race and the highly granular area deprivation index in liver transplant evaluation.Clinical transplantation · 2023Article
- Post-acute care transitions and outcomes among Medicare beneficiaries with dementia: Associations with race/ethnicity and dual status.Health services research · 2023Observational
- An age-friendly population health dashboard geolocating by clinical and social determinant needs.Health services research · 2023Article
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Authors and funding
10 authors at 2 institutions in 1 country.
Funding
Abstract
objectiveTo determine whether neighborhood socioeconomic disadvantage, as determined by the Area Deprivation Index, increases 30-day hospital re-observation risk. PARTICIPANTS AND
methodsThis retrospective study of 20% Medicare fee-for-service beneficiary observation stays from January 1, 2014, to November 30, 2014, included 319,980 stays among 273,308 beneficiaries. We evaluated risk for a 30-day re-observation following an index observation stay for those living in the 15% most disadvantaged compared with the 85% least disadvantaged neighborhoods.
resultsOverall, 4.5% (270,600 of 6,080,664) of beneficiaries had index observation stays, which varied by disadvantage (4.3% [232,568 of 5,398,311] in the least disadvantaged 85% compared with 5.6% [38,032 of 682,353] in the most disadvantaged 15%). Patients in the most disadvantaged neighborhoods had a higher 30-day re-observation rate (2857 of 41,975; 6.8%) compared with least disadvantaged neighborhoods (13,543 of 278,005; 4.9%); a 43% increased risk (unadjusted odds ratio [OR], 1.43; 95% CI, 1.31 to 1.55). After adjustment, this risk remained (adjusted OR, 1.13; 95% CI, 1.04 to 1.22). Discharge to a skilled nursing facility reduced 30-day re-observation risk (OR, 0.63; 95% CI, 0.57 to 0.69), whereas index observation length of stay of 4 or more days (3 midnights) conferred increased risk (OR, 1.29; 95% CI, 1.09 to 1.52); those living in disadvantaged neighborhoods were less likely to discharge to skilled nursing facilities and more likely to have long index stays. Beneficiaries with more than one 30-day re-observation (chronic re-observation) had progressively greater disadvantage by number of stays (adjusted incident rate ratio, 1.08; 95% CI, 1.02 to 1.14). Observation prevalence varied nationally.
conclusionThirty-day re-observation, especially chronic re-observation, is highly associated with socioeconomic neighborhood disadvantage, even after accounting for factors such as race, disability, and Medicaid eligibility. Beneficiaries least able to pay are potentially most vulnerable to costs from serial re-observations and challenges of Medicare observation policy, which may discourage patients from seeking necessary care.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.