One in five Medicare patients returns to the hospital after ‘observation stays’

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As many as one in five older Medicare patients returns to the hospital after an observation stay, or short-term outpatient stay, a Yale-led study found. This high rate of revisit to the hospital points to a hidden vulnerability among these patients, and suggests changes in care might be needed, the researchers said.

The study was published online June 20 in The BMJ.

Observation stays are a relatively new category of hospital care. These stays typically follow an emergency department (ED) visit and last less than 24 hours before patients are discharged. The most common conditions treated during an observation stay are cardiovascular, such as chest pain or arrhythmia.

While observation stays have increased in recent years as alternatives to inpatient stays, little research has been done to assess their associated outcomes for patients, said first author Kumar Dharmarajan, M.D., assistant professor of medicine. It’s estimated that 1.5 million patients are affected by this trend.

To assess outcomes following observation stays among older patients, Dharmarajan and his co-authors analyzed nationally representative data on Medicare beneficiaries from 2006 to 2011. The researchers calculated hospital revisit rates and mortality rates in the 30 days following discharge from an observation stay. They compared that data with the same outcomes for Medicare recipients who had an initial inpatient stay or received care in the ED.

The research team found that a significant number of observation stay patients returned to the hospital. “We found that in the 30 days after discharge, one in five patients had a revisit, such as an ED stay, another observation stay, or inpatient stay,” said Dharmarajan. “Half of those revisits were for inpatient care and these revisits increased over time,” he noted.

The outcomes following observation stays were similar to outcomes after ED visits, the researchers said.

Due to changes in how the federal government and insurers reimburse inpatient stays, the problem of frequent revisits after observation stays may grow, they note.

“The findings are important because a revisit rate of one in five suggests that patients are vulnerable after discharge to adverse health events,” Dharmarajan said. “Strategies designed to improve care for patients after inpatient stays may also be helpful after observation stays.”

Such strategies might include better care for patients transitioning from the hospital, and improved post-acute care, the researchers added.  

Other authors are Li Qin, Maggie Bierlein, Jennie Choi, Zhenqiu Lin, Nihar Desai, Erica Spatz, Harlan Krumholz, and Arjun Venkatesh.

The authors’ study was supported by the National Institute on Aging, the American Federation for Aging Research, the Yale Claude D. Pepper Older Americans Independence Center, the Agency for Healthcare Research and Quality, the Emergency Medicine Foundation, and the Centers for Medicare & Medicaid Services. Competing interests are disclosed in the study.

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