ArticleJournal of general internal medicine1997
A regional evaluation of variation in low-severity hospital admissions.
Article in Journal of general internal medicine, 1997. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 13 papers.
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Who cites it
13 citing papers in PubMed.
- A Pragmatic, Stepped-Wedge, Cluster-controlled Clinical Trial of Real-Time Pneumonia Clinical Decision Support.American journal of respiratory and critical care medicine · 2022Trial
- Factors other than medical acuity that influence hospitalisation: a scoping review protocol.BMJ open · 2019Article
- Implementation of Real-Time Electronic Clinical Decision Support for Emergency Department Patients with Pneumonia Across a Healthcare System.AMIA ... Annual Symposium proceedings. AMIA Symposium · 2019Article
- Hospitalized Patients with Acute Pneumonia.Hospital medicine clinics · 2017Review
- Wide Variability in Emergency Physician Admission Rates: A Target to Reduce Costs Without Compromising Quality.The western journal of emergency medicine · 2016Observational
- Estimating True Resource Costs of Outpatient Care for Medicare Beneficiaries: Standardized Costs versus Medicare Payments and Charges.Health services research · 2016Article
- Quantifying Geographic Variation in Health Care Outcomes in the United States before and after Risk-Adjustment.PloS one · 2016Article
- Validating hospital admission criteria for decision support in pneumonia.BMC pulmonary medicine · 2014Article
- Estimation of standardized hospital costs from Medicare claims that reflect resource requirements for care: impact for cohort studies linked to Medicare claims.Health services research · 2014Article
- Hospital admission decision for patients with community-acquired pneumonia: variability among physicians in an emergency department.Annals of emergency medicine · 2012Article
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- Older persons' preferences for site of treatment in acute illness.Journal of general internal medicine · 1998Article
Corrections and comments
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Authors and funding
4 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectiveDetermine patient and hospital-level variation in proportions of low-severity admissions.
designRetrospective cohort study.
settingThirty hospitals in a large metropolitan region. PATIENTS: A total of 43,209 consecutive eligible patients discharged in 1991 through 1993 with congestive heart failure (n = 25,213) or pneumonia (n = 17,995). MEASUREMENTS AND MAIN
resultsAdmission severity of illness was measured from validated multivariable models that estimated the risk of in-hospital death; models were based on clinical data abstracted from patients' medical records. Admissions were categorized as "low severity" if the predicted risk of death was less than 1%. Nearly 15% of patients (n = 6,382) were categorized as low-severity admissions. Compared with other patients, low-severity admissions were more likely (p < .001) to be nonwhite and to have Medicaid or be uninsured. Low-severity admissions had shorter median length of stay (4 vs 7 days; p < .001), but accounted for 10% of the total number of hospital days. For congestive heart failure, proportions of low-severity admissions across hospitals ranged from 10% to 25%; 12 hospitals had rates that were significantly different (p < .01) than the overall rate of 17%. For pneumonia, proportions ranged from 3% to 22%; 12 hospitals had rates different from the overall rate of 12%. Variation across hospitals remained after adjusting for patient sociodemographic factors.
conclusionsRates of low-severity admissions for congestive heart failure and pneumonia varied across hospitals and were higher among nonwhite and poorly insured patients. Although the current study does not identify causes of this variability, possible explanations include differences in access to ambulatory services, decisions to admit patients for clinical indications unrelated to the risk of hospital mortality, and variability in admission practices of individual physicians and hospitals. The development of protocols for ambulatory management of low-severity patients and improvement of access to outpatient care would most likely decrease the utilization of more costly hospital services.
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