title: Outcomes associated with observation versus short-stay admission among chest pain patients in the Veterans Health Administration.
abstract: BACKGROUND
  To determine the extent to which 30- and 90-day hospital readmission and mortality rates differ as a function of whether a chest pain patient is placed in observation status or admitted to the hospital for a short-stay (<48 h).
  
  
  METHODS
  Using 114,043 observation stays and short-stay admissions for chest pain at Veterans Health Administration hospitals between 2005 and 2013, we estimated event-level logistic regression models using a generalized estimating equation framework to predict 30 and 90-day readmissions and mortality as a function of whether the patient had an observation stay or a short-stay admission. We also adjusted for a variety of patient characteristics and unobserved time-invariant hospital factors.
  
  
  RESULTS
  Relative to the short-stay inpatient group, veterans with chest pain who were placed in observation status were significantly more likely to be female (7.0 % vs. 6.4 %, White (76.6 % vs. 71.0 %, and from a rural area (28.3 % vs. 20.2 %). There were no other meaningful differences between the groups. Veterans with chest pain who were placed in observation status had 25 % lower odds of dying within 30 days (95 % confidence interval [CI]: 3 % - 43 %) and 12 % lower odds of a 30-day readmission (95 % CI: 6 % - 17 %) compared to those admitted as short-stay inpatients. Neither 90-day outcome was significantly associated with placement in observation status. Patient demographics were also important predictors of mortality and readmissions.
  
  
  CONCLUSIONS
  There are clinically observable differences in outcomes between patients admitted to observation and those admitted as short-stay inpatients. We find no evidence that the increase in observation stays reflects a lack of proper care for patients placed in observation status.
authors.affiliation: Department of Health Management and Policy, College of Public Health, University of Iowa, 145 North Riverside Drive, N240 CPHB, Iowa City, IA, 52242, USA. brad-wright@uiowa.edu.|Public Policy Center, University of Iowa, Iowa City, IA, USA. brad-wright@uiowa.edu.
authors.forename: Brad
authors.identifier: http://orcid.org/0000-0002-2674-4951
authors.initials: B
authors.lastname: Wright
authors.affiliation: Iowa City Veterans Affairs Healthcare System, The Comprehensive Access and Delivery, Research and Evaluation Center (CADRE), Iowa City, IA, 52242, USA.|Department of Internal Medicine, Carver College of Medicine, University of Iowa, Iowa City, IA, 52242, USA.
authors.forename: Amy M J
authors.initials: AM
authors.lastname: O'Shea
authors.affiliation: Christiana Care Health System Department of Internal Medicine and Christiana Care Health System Value Institute, Wilmington, DE, USA.
authors.forename: Justin M
authors.initials: JM
authors.lastname: Glasgow
authors.affiliation: Department of Health Management and Policy, College of Public Health, University of Iowa, 145 North Riverside Drive, N240 CPHB, Iowa City, IA, 52242, USA.
authors.forename: Padmaja
authors.initials: P
authors.lastname: Ayyagari
authors.affiliation: Iowa City Veterans Affairs Healthcare System, The Comprehensive Access and Delivery, Research and Evaluation Center (CADRE), Iowa City, IA, 52242, USA.|Department of Internal Medicine, Carver College of Medicine, University of Iowa, Iowa City, IA, 52242, USA.
authors.forename: Mary
authors.initials: M
authors.lastname: Vaughan-Sarrazin
keywords: Mortality; Observation stays; Readmissions; Short-stay admissions; Veterans Health Administration