title: Observation Status or Inpatient Admission: Impact of Patient Disposition on Outcomes and Utilization Among Emergency Department Patients With Chest Pain.
abstract: to compare healthcare utilization including coronary angiography, percutaneous coronary intervention (PCI), rehospitalization, and rate of subsequent acute myocardial infarction (AMI) within 30 days, among patients presenting to the emergency department (ED) with chest pain admitted as short-term inpatient (≤2 days) versus observation (in-ED observation units combined with in-hospital observation).
  
  
  
  We identified adults diagnosed with acute chest pain in the ED from 2010 to 2014 using administrative claims from privately insured and Medicare Advantage. Patients having AMI during the index visit were excluded. One-to-one propensity-score matching and logistic regression were used. Odds ratios (ORs) with 95% confidence intervals (CIs) were reported.
  
  
  
  A total of 774,017 chest pain visits were included. After matching, healthcare utilization was lower among observation versus short inpatient, with 10.9% versus 24.4% (OR = 0.38, 95% CI = 0.36 to 0.39) undergoing cardiac catheterization and 1.8% versus 7.6% (OR = 0.23, 95% CI = 0.21 to 0.24) having PCI. The incidence of subsequent AMI within the following 30 days was similar in patients admitted as observation versus short inpatient (0.23% vs. 0.21%; OR = 1.09, 95% CI = 0.84 to 1.42).
  
  
  
  There were higher rates of cardiac catheterization and PCI among those admitted as a short inpatient compared to observation, while the incidence of subsequent AMI within 30 days was similar.
authors.affiliation: Department of Emergency Medicine, Mayo Clinic, Rochester, MN.|Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN.
authors.forename: M Fernanda
authors.initials: MF
authors.lastname: Bellolio
authors.affiliation: Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN.
authors.forename: Lindsey R
authors.initials: LR
authors.lastname: Sangaralingham
authors.affiliation: Department of Health Science Research, Mayo Clinic, Rochester, MN.
authors.forename: Stephanie R
authors.initials: SR
authors.lastname: Schilz
authors.affiliation: AARP Public Policy Institute, Washington, DC.
authors.forename: Claire M
authors.initials: CM
authors.lastname: Noel-Miller
authors.affiliation: AARP Public Policy Institute, Washington, DC.
authors.forename: Keith D
authors.initials: KD
authors.lastname: Lind
authors.affiliation: OptumLabs™, Cambridge, MA.
authors.forename: Pamela E
authors.initials: PE
authors.lastname: Morin
authors.affiliation: Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN.|Division of Cardiovascular Diseases, Department of Internal Medicine, Mayo Clinic, Rochester, MN.
authors.forename: Peter A
authors.initials: PA
authors.lastname: Noseworthy
authors.affiliation: Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN.|Department of Health Science Research, Mayo Clinic, Rochester, MN.|OptumLabs™, Cambridge, MA.
authors.forename: Nilay D
authors.initials: ND
authors.lastname: Shah
authors.affiliation: Department of Emergency Medicine, Mayo Clinic, Rochester, MN.|Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN.
authors.forename: Erik P
authors.initials: EP
authors.lastname: Hess
mesh_terms: D000328:Adult; D000368:Aged; D002637:Chest Pain / Q000175:diagnosis* / Q000209:etiology; D016208:Databases, Factual; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis; D016017:Odds Ratio; D013997:Time Factors