Publication Type

Journal Article

Version

publishedVersion

Publication Date

1-2018

Abstract

To examine racial and geographic disparities in the use of-and outcomes associated with-Medicare observation stays versus short-stay hospitalizations.\nWe used 2007-2010 fee-for-service Medicare claims, including 3,555,994 observation and short-stay hospitalizations for individuals over age 65. We estimated linear probability models with hospital fixed effects to identify within-facility disparities in observation stay use, and estimated in-hospital mortality, and 30- and 90-day post-discharge mortality, return ED visits, and hospital readmissions as a function of placement in observation using linear probability models, propensity-score matching, and interaction terms.\nWe identified racial and geographic disparities in the likelihood of observation stay use within hospitals (blacks 3.9 percentage points more likely than whites, rural 5.4 percentage points less likely than urban). Observation is associated with an increased likelihood of returning to the ED within 30 or 90-days, and a decreased likelihood of readmission or mortality, but there are racial and geographic disparities in these outcomes.\nWhile observation generally results in improved outcomes, disparities in these outcomes and the use of observation stays within hospitals are concerning, and may be driven by clinical and non-clinical factors.\nPurpose\nMethods\nResults\nConclusion

Discipline

Health Economics

Research Areas

Applied Microeconomics

Publication

Health Equity

Volume

2

Issue

1

First Page

45

Last Page

54

ISSN

2473-1242

Identifier

10.1089/heq.2017.0055

Publisher

Mary Ann Liebert

Additional URL

https://doi.org/10.1089/heq.2017.0055

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