title: One-year outcomes associated with using observation services in triaging patients with nonspecific chest pain.
abstract: BACKGROUND
  Observation services are provided in greatly variant settings. The aim of this study was to reexamine the effectiveness of observation services compared to inpatient units for patients with nonspecific chest pain.
  
  
  OBJECTIVE
  Patients admitted to observation units have similar outcomes to patients admitted to inpatient wards.
  
  
  METHODS
  We conducted a claim-based retrospective study for 7549 patients who were admitted to observation and inpatient units. Both models of care were evaluated using the 1-year costs related to chest pain/cardiovascular diseases, and primary and secondary outcomes. Primary outcome was a composite of myocardial infarction, congestive heart failure, stroke, or cardiac arrest, whereas secondary outcomes included revascularization procedures, emergency room revisits, and hospitalization due to cardiovascular diseases.
  
  
  RESULTS
  Two-thirds (65.7%, n = 4962) of patients in the sample had observation services, and 34.3% (n = 2587) were admitted to inpatient care. Of the inpatient group, 4.9% experienced a total of 167 primary outcomes, whereas 14.1% experienced a total of 571 secondary outcomes. In comparison, 3.8% of the observation group experienced 238 primary outcomes, and 10.3% experienced 737 secondary outcomes. After adjusting for baseline characteristics using Cox proportional hazard and quantile regression models, no differences between the 2 groups were detected in the 1-year costs of cardiovascular services and primary or secondary outcomes. Patients who had observation services were 79% (95% confidence interval: 1.24-2.58) more likely to have revascularization procedures compared to those admitted to inpatient care.
  
  
  CONCLUSIONS
  Patients who had observation services had similar outcomes and 1-year costs compared to patients admitted to inpatient wards.
authors.affiliation: Division of Management, Policy and Community Health, University of Texas School of Public Health, Houston, Texas.
authors.forename: Ibrahim M
authors.initials: IM
authors.lastname: Abbass
authors.forename: Salim S
authors.initials: SS
authors.lastname: Virani
authors.forename: J
authors.initials: J
authors.lastname: Michael Swint
authors.forename: Wenyaw
authors.initials: W
authors.lastname: Chan
authors.forename: Luisa
authors.initials: L
authors.lastname: Franzini
mesh_terms: D000328:Adult; D000368:Aged; D002637:Chest Pain / Q000209:etiology* / Q000628:therapy; D004636:Emergency Service, Hospital / Q000458:organization & administration*; D005260:Female; D006331:Heart Diseases / Q000150:complications* / Q000175:diagnosis* / Q000628:therapy; D006801:Humans; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic / Q000379:methods; D064887:Observational Studies as Topic / Q000379:methods / Q000706:statistics & numerical data*; D016017:Odds Ratio; D017063:Outcome Assessment, Health Care / Q000191:economics / Q000706:statistics & numerical data*; D010343:Patient Admission / Q000706:statistics & numerical data; D012189:Retrospective Studies; D018570:Risk Assessment; D014218:Triage / Q000706:statistics & numerical data*
references.citation: Natl Health Stat Report. 2010 Aug 6;(26):1-31
references.pmid: 20726217
references.citation: Acad Emerg Med. 2011 Sep;18(9):959-65
references.pmid: 21883638
references.citation: BMC Public Health. 2006 Jun 28;6:171
references.pmid: 16805909
references.citation: Health Aff (Millwood). 2013 Dec;32(12):2149-56
references.pmid: 24301399
references.citation: N Engl J Med. 1998 Dec 24;339(26):1882-8
references.pmid: 9862943
references.citation: Crit Pathw Cardiol. 2012 Sep;11(3):128-38
references.pmid: 22825533
references.citation: Clin Cardiol. 2014 Mar;37(3):140-5
references.pmid: 24452666
references.citation: J Am Coll Cardiol. 1994 Nov 1;24(5):1249-59
references.pmid: 7930247
references.citation: JAMA Intern Med. 2013 Nov 25;173(21):1991-8
references.pmid: 23835927
references.citation: J Am Coll Cardiol. 1996 Jul;28(1):25-33
references.pmid: 8752791
references.citation: Am J Cardiol. 1997 Sep 1;80(5):563-8
references.pmid: 9294982
references.citation: Med Care. 2011 Oct;49(10):932-9
references.pmid: 21478773
references.citation: PLoS One. 2011;6(9):e24326
references.pmid: 21935398
references.citation: Am Heart J. 2011 May;161(5):871-7
references.pmid: 21570516