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Hospital, Patient, and Local Health System Characteristics Associated with the Prevalence and Duration of Observation Care

Authors

  • Brad Wright Ph.D.,

    Corresponding author
    1. Department of Health Management and Policy, University of Iowa College of Public Health, Iowa City, IA 52242
    • Address correspondence to Brad Wright, Ph.D., Department of Health Management and Policy, University of Iowa College of Public Health, 100 College of Public Health Building N240, Iowa City, IA 52242; e-mail: brad-wright@uiowa.edu.

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  • Hye-Young Jung Ph.D.,

    1. Department of Health Services, Policy and Practice, Brown University, Providence, RI
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  • Zhanlian Feng Ph.D.,

    1. Department of Health Services, Policy and Practice, Brown University, Providence, RI
    2. RTI International, Waltham, MA
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  • Vincent Mor Ph.D.

    1. Department of Health Services, Policy and Practice, Brown University, Providence, RI
    2. Center for Gerontology and Health Care Research, Brown University, Providence, RI
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Abstract

Objective

To examine the association between hospital, patient, and local health system characteristics and the likelihood, prevalence, and duration of observation care among fee-for-service Medicare beneficiaries.

Data Sources

The 100 percent Medicare inpatient and outpatient claims and enrollment files for 2009, supplemented with 2007 American Hospital Association Survey and 2009 Area Resource File data.

Study Design

Using a lagged cross-sectional design, we model the likelihood of a hospital providing any observation care using logistic regression and the conditional prevalence and duration of observation care using linear regression, among 3,692 general hospitals in the United States.

Principle Findings

Critical access hospitals (CAHs) have 97 percent lower odds of providing observation care compared to other hospitals, and they conditionally provide three fewer observation stays per 1,000 visits. The provision of observation care is negatively associated with the proportion of racial minority patients, but positively associated with average patient age, proportion of outpatient visits occurring in the emergency room, and diagnostic case mix. Duration is between 1.5 and 2.8 hours shorter at government-owned, for-profit hospitals, and CAHs compared to other nonprofit hospitals.

Conclusions

Variation in observation care depends primarily on hospital characteristics, patient characteristics, and geographic measures. By contrast, local health system characteristics are not a factor.

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