title: Hospital, patient, and local health system characteristics associated with the prevalence and duration of observation care.
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.
  
  
  METHODS
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
authors.affiliation: Department of Health Management and Policy, University of Iowa College of Public Health, 100 College of Public Health Building N240, Iowa City, IA 52242.
authors.forename: Brad
authors.initials: B
authors.lastname: Wright
authors.forename: Hye-Young
authors.initials: HY
authors.lastname: Jung
authors.forename: Zhanlian
authors.initials: Z
authors.lastname: Feng
authors.forename: Vincent
authors.initials: V
authors.lastname: Mor
mesh_terms: D000368:Aged; D000553:Ambulatory Care / Q000706:statistics & numerical data; D003153:Community Health Services; D003430:Cross-Sectional Studies; D004636:Emergency Service, Hospital / Q000458:organization & administration; D005260:Female; D019538:Health Care Surveys; D006742:Hospital Bed Capacity; D006760:Hospitalization / Q000706:statistics & numerical data*; D006769:Hospitals, General / Q000145:classification* / Q000458:organization & administration; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D016013:Likelihood Functions; D016014:Linear Models; D008297:Male; D006278:Medicare; D014481:United States; D057832:Watchful Waiting / Q000706:statistics & numerical data*
keywords: Medicare; Observation status; elderly; hospitals; observation care