PDF(Pubmed)
Abstract：
Hospitals within the Veterans Affairs (VA) health care system exhibited growing use of observation care. It is unknown how this affected VA hospital performance since observation care is not included in acute inpatient measures. To examine changes in VA hospitalization outcomes and whether it was affected by shifting acute inpatient care to observation care. Longitudinal analysis of 986,355 acute hospitalizations and observation stays in 11 states 2011 to 2017. We estimated temporal changes in 30-day mortality, 30-day readmissions, costs, and length of stay (LOS) for all hospitalizations and 6 conditions in adjusted models. Changes in mortality and readmissions were compared including and excluding observation care. A 9% drop in acute hospitalizations was offset by a 157% increase in observation stays 2011 to 2017. A 30-day mortality decreased but readmissions did not when observation stays were included (all P < .05). Mean costs increased modestly; mean LOS was unchanged. There were differences by condition. VA hospital mortality decreased; there was no change in readmissions.
摘要：
退伍军人事务（VA）医疗保健系统中的医院越来越多地使用观察护理。由于急性住院措施中未包括观察护理，因此尚不清楚这如何影响VA医院的表现。检查VA住院结局的变化，以及是否受将急性住院护理转变为观察护理的影响。2011年至2017年11个州986,355例急性住院和观察住院的纵向分析。我们估计了30天死亡率的时间变化，再入院30天,成本,在调整后的模型中，所有住院和6种情况的住院时间（LOS）。比较了死亡率和再入院率的变化，包括和不包括观察护理。急性住院人数下降了9%，被2011年至2017年观察住院人数增加了157%所抵消。30天的死亡率降低，但当包括观察住院时，再入院没有降低（所有P<0.05）。平均成本增加适度；平均LOS没有变化。根据条件存在差异。VA医院死亡率下降；再入院没有变化。
