Resource utilization for observation-status stays at children's hospitals

Evan S. Fieldston, Samir S. Shah, Matthew Hall, Paul D. Hain, Elizabeth R. Alpern, Mark A. Del Beccaro, John Harding, Michelle L. MacY

Research output: Contribution to journalArticle

16 Citations (Scopus)

Abstract

BACKGROUND AND OBJECTIVE: Observation status, in contrast to inpatient status, is a billing designation for hospital payment. Observation status stays are presumed to be shorter and less resource-intensive, but utilization for pediatric observation-status stays has not been studied. The goal of this study was to describe resource utilization characteristics for patients in observation and inpatient status in a national cohort of hospitalized children in the Pediatric Health Information System. METHODS: This study was a retrospective cohort from 2010 of observation- and inpatient-status stays of ≤2 days; all children were admitted from the emergency department. Costs were analyzed and described. Comparison between costs adjusting for age, severity, and length of stay were conducted by using random-effect mixed models to account for clustering of patients within hospitals. RESULTS: Observation status was assigned to 67 230 (33.3%) discharges, but its use varied across hospitals (2%-45%). Observationstatus stays had total median costs of $2559, including room costs and $678 excluding room costs. Twenty-five diagnoses accounted for 74% of stays in observation status, 4 of which were used for detailed analyses: asthma (n = 6352), viral gastroenteritis (n = 4043), bronchiolitis (n = 3537), and seizure (n = 3289). On average, after risk adjustment, observation-status stays cost $260 less than inpatient-status stays for these select 4 diagnoses. Large overlaps in costs were demonstrated for both types of stay. CONCLUSIONS: Variability in use of observation status with large overlap in costs and potential lower reimbursement compared with inpatient status calls into question the utility of segmenting patients according to billing status and highlights a financial risk for institutions with a high volume of pediatric patients in observation status.

Original languageEnglish (US)
Pages (from-to)1050-1058
Number of pages9
JournalPediatrics
Volume131
Issue number6
DOIs
StatePublished - Jun 2013

Fingerprint

Observation
Costs and Cost Analysis
Inpatients
Pediatrics
Resources
Health Information Systems
Risk Adjustment
Bronchiolitis
Hospitalized Child
Costs
Gastroenteritis
Cluster Analysis
Hospital Emergency Service
Length of Stay
Seizures
Asthma

Keywords

  • Health care finance
  • Hospital costs
  • Hospitalization
  • Hospitalizedchild
  • Observation status
  • Patient admission
  • Patient discharge
  • Pediatric hospital

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Arts and Humanities (miscellaneous)

Cite this

Fieldston, E. S., Shah, S. S., Hall, M., Hain, P. D., Alpern, E. R., Del Beccaro, M. A., ... MacY, M. L. (2013). Resource utilization for observation-status stays at children's hospitals. Pediatrics, 131(6), 1050-1058. https://doi.org/10.1542/peds.2012-2494

Resource utilization for observation-status stays at children's hospitals. / Fieldston, Evan S.; Shah, Samir S.; Hall, Matthew; Hain, Paul D.; Alpern, Elizabeth R.; Del Beccaro, Mark A.; Harding, John; MacY, Michelle L.

In: Pediatrics, Vol. 131, No. 6, 06.2013, p. 1050-1058.

Research output: Contribution to journalArticle

Fieldston, ES, Shah, SS, Hall, M, Hain, PD, Alpern, ER, Del Beccaro, MA, Harding, J & MacY, ML 2013, 'Resource utilization for observation-status stays at children's hospitals', Pediatrics, vol. 131, no. 6, pp. 1050-1058. https://doi.org/10.1542/peds.2012-2494
Fieldston ES, Shah SS, Hall M, Hain PD, Alpern ER, Del Beccaro MA et al. Resource utilization for observation-status stays at children's hospitals. Pediatrics. 2013 Jun;131(6):1050-1058. https://doi.org/10.1542/peds.2012-2494
Fieldston, Evan S. ; Shah, Samir S. ; Hall, Matthew ; Hain, Paul D. ; Alpern, Elizabeth R. ; Del Beccaro, Mark A. ; Harding, John ; MacY, Michelle L. / Resource utilization for observation-status stays at children's hospitals. In: Pediatrics. 2013 ; Vol. 131, No. 6. pp. 1050-1058.
@article{7f20312978dc47e8b1b41fb417a102d4,
title = "Resource utilization for observation-status stays at children's hospitals",
abstract = "BACKGROUND AND OBJECTIVE: Observation status, in contrast to inpatient status, is a billing designation for hospital payment. Observation status stays are presumed to be shorter and less resource-intensive, but utilization for pediatric observation-status stays has not been studied. The goal of this study was to describe resource utilization characteristics for patients in observation and inpatient status in a national cohort of hospitalized children in the Pediatric Health Information System. METHODS: This study was a retrospective cohort from 2010 of observation- and inpatient-status stays of ≤2 days; all children were admitted from the emergency department. Costs were analyzed and described. Comparison between costs adjusting for age, severity, and length of stay were conducted by using random-effect mixed models to account for clustering of patients within hospitals. RESULTS: Observation status was assigned to 67 230 (33.3{\%}) discharges, but its use varied across hospitals (2{\%}-45{\%}). Observationstatus stays had total median costs of $2559, including room costs and $678 excluding room costs. Twenty-five diagnoses accounted for 74{\%} of stays in observation status, 4 of which were used for detailed analyses: asthma (n = 6352), viral gastroenteritis (n = 4043), bronchiolitis (n = 3537), and seizure (n = 3289). On average, after risk adjustment, observation-status stays cost $260 less than inpatient-status stays for these select 4 diagnoses. Large overlaps in costs were demonstrated for both types of stay. CONCLUSIONS: Variability in use of observation status with large overlap in costs and potential lower reimbursement compared with inpatient status calls into question the utility of segmenting patients according to billing status and highlights a financial risk for institutions with a high volume of pediatric patients in observation status.",
keywords = "Health care finance, Hospital costs, Hospitalization, Hospitalizedchild, Observation status, Patient admission, Patient discharge, Pediatric hospital",
author = "Fieldston, {Evan S.} and Shah, {Samir S.} and Matthew Hall and Hain, {Paul D.} and Alpern, {Elizabeth R.} and {Del Beccaro}, {Mark A.} and John Harding and MacY, {Michelle L.}",
year = "2013",
month = "6",
doi = "10.1542/peds.2012-2494",
language = "English (US)",
volume = "131",
pages = "1050--1058",
journal = "Pediatrics",
issn = "0031-4005",
publisher = "American Academy of Pediatrics",
number = "6",

}

TY - JOUR

T1 - Resource utilization for observation-status stays at children's hospitals

AU - Fieldston, Evan S.

AU - Shah, Samir S.

AU - Hall, Matthew

AU - Hain, Paul D.

AU - Alpern, Elizabeth R.

AU - Del Beccaro, Mark A.

AU - Harding, John

AU - MacY, Michelle L.

PY - 2013/6

Y1 - 2013/6

N2 - BACKGROUND AND OBJECTIVE: Observation status, in contrast to inpatient status, is a billing designation for hospital payment. Observation status stays are presumed to be shorter and less resource-intensive, but utilization for pediatric observation-status stays has not been studied. The goal of this study was to describe resource utilization characteristics for patients in observation and inpatient status in a national cohort of hospitalized children in the Pediatric Health Information System. METHODS: This study was a retrospective cohort from 2010 of observation- and inpatient-status stays of ≤2 days; all children were admitted from the emergency department. Costs were analyzed and described. Comparison between costs adjusting for age, severity, and length of stay were conducted by using random-effect mixed models to account for clustering of patients within hospitals. RESULTS: Observation status was assigned to 67 230 (33.3%) discharges, but its use varied across hospitals (2%-45%). Observationstatus stays had total median costs of $2559, including room costs and $678 excluding room costs. Twenty-five diagnoses accounted for 74% of stays in observation status, 4 of which were used for detailed analyses: asthma (n = 6352), viral gastroenteritis (n = 4043), bronchiolitis (n = 3537), and seizure (n = 3289). On average, after risk adjustment, observation-status stays cost $260 less than inpatient-status stays for these select 4 diagnoses. Large overlaps in costs were demonstrated for both types of stay. CONCLUSIONS: Variability in use of observation status with large overlap in costs and potential lower reimbursement compared with inpatient status calls into question the utility of segmenting patients according to billing status and highlights a financial risk for institutions with a high volume of pediatric patients in observation status.

AB - BACKGROUND AND OBJECTIVE: Observation status, in contrast to inpatient status, is a billing designation for hospital payment. Observation status stays are presumed to be shorter and less resource-intensive, but utilization for pediatric observation-status stays has not been studied. The goal of this study was to describe resource utilization characteristics for patients in observation and inpatient status in a national cohort of hospitalized children in the Pediatric Health Information System. METHODS: This study was a retrospective cohort from 2010 of observation- and inpatient-status stays of ≤2 days; all children were admitted from the emergency department. Costs were analyzed and described. Comparison between costs adjusting for age, severity, and length of stay were conducted by using random-effect mixed models to account for clustering of patients within hospitals. RESULTS: Observation status was assigned to 67 230 (33.3%) discharges, but its use varied across hospitals (2%-45%). Observationstatus stays had total median costs of $2559, including room costs and $678 excluding room costs. Twenty-five diagnoses accounted for 74% of stays in observation status, 4 of which were used for detailed analyses: asthma (n = 6352), viral gastroenteritis (n = 4043), bronchiolitis (n = 3537), and seizure (n = 3289). On average, after risk adjustment, observation-status stays cost $260 less than inpatient-status stays for these select 4 diagnoses. Large overlaps in costs were demonstrated for both types of stay. CONCLUSIONS: Variability in use of observation status with large overlap in costs and potential lower reimbursement compared with inpatient status calls into question the utility of segmenting patients according to billing status and highlights a financial risk for institutions with a high volume of pediatric patients in observation status.

KW - Health care finance

KW - Hospital costs

KW - Hospitalization

KW - Hospitalizedchild

KW - Observation status

KW - Patient admission

KW - Patient discharge

KW - Pediatric hospital

UR - http://www.scopus.com/inward/record.url?scp=84878703961&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84878703961&partnerID=8YFLogxK

U2 - 10.1542/peds.2012-2494

DO - 10.1542/peds.2012-2494

M3 - Article

C2 - 23669520

AN - SCOPUS:84878703961

VL - 131

SP - 1050

EP - 1058

JO - Pediatrics

JF - Pediatrics

SN - 0031-4005

IS - 6

ER -