title: Observation Rates At Veterans' Hospitals More Than Doubled During 2005-13, Similar To Medicare Trends.
abstract: When neither inpatient admission nor prompt discharge is clearly indicated for a patient in the emergency department, physicians place the patient under observation in a hospital for diagnosis and treatment. The increasing prevalence of observation stays at hospitals reimbursed by Medicare is receiving considerable attention, but the prevalence remains unexplored in Veterans Health Administration (VHA) hospitals, which are subject to different payment policies. Using VHA data for fiscal years 2005-13, we identified trends and variations in observation rates across twenty-one Veteran Integrated Service Networks and 128 VHA hospitals nationwide. We found that observation rates across VHA hospitals more than doubled, from 6.5 percent to 13.8 percent, and that there was substantial variation across both Veteran Integrated Service Networks and hospitals. The most prevalent diagnoses accounted for an increasing share of observation stays over time. Despite different incentives within the VHA and Medicare, rates of observation have increased over time for both populations.
authors.affiliation: Brad Wright (brad-wright@uiowa.edu) is an assistant professor in the Department of Health Management and Policy and at the Public Policy Center, both at the University of Iowa, in Iowa City.
authors.forename: Brad
authors.initials: B
authors.lastname: Wright
authors.affiliation: Amy M. J. O'Shea is a research health specialist at the Iowa City Veterans Affairs Healthcare System and a research associate in the Department of Internal Medicine, Carver College of Medicine, at the University of Iowa.
authors.forename: Amy M J
authors.initials: AM
authors.lastname: O'Shea
authors.affiliation: Padmaja Ayyagari is an assistant professor in the Department of Health Management and Policy at the University of Iowa.
authors.forename: Padmaja
authors.initials: P
authors.lastname: Ayyagari
authors.affiliation: Patience G. Ugwi is a doctoral student in the Department of Health Management and Policy at the University of Iowa.
authors.forename: Patience G
authors.initials: PG
authors.lastname: Ugwi
authors.affiliation: Peter Kaboli is an investigator at the Iowa City Veterans Affairs Healthcare System and a professor in the Department of Internal Medicine, Carver College of Medicine, at the University of Iowa.
authors.forename: Peter
authors.initials: P
authors.lastname: Kaboli
authors.affiliation: Mary Vaughan Sarrazin is an investigator at the Iowa City Veterans Affairs Healthcare System and an associate professor in the Department of Internal Medicine, Carver College of Medicine, at the University of Iowa.
authors.forename: Mary
authors.initials: M
authors.lastname: Vaughan Sarrazin
mesh_terms: D006760:Hospitalization / Q000706:statistics & numerical data*; D006787:Hospitals, Veterans / Q000191:economics* / Q000706:statistics & numerical data*; D006801:Humans; D006278:Medicare / Q000706:statistics & numerical data*; D014481:United States / Q000453:epidemiology; D014493:United States Department of Veterans Affairs
keywords: Hospitals; Observation Care; Organization and Delivery of Care; Veterans Affairs Medical Center