Outcomes and Affordability of Observation Status for Children (OASIS)

儿童观察状态的结果和承受能力 (OASIS)

• 批准号: 10736097
• 负责人: Mehul V. Raval
• 金额: $ 40万
• 依托单位: NORTHWESTERN UNIVERSITY AT CHICAGO
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-07-03 至 2028-04-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10736097
• 关键词: Outcomes; Affordability; Observation; Status; Children

PROJECT ABSTACT It is estimated that ~500,000 (34%) pediatric hospital stays each year in the United States (US) are designated as outpatient under “observation status” and often referred to as observation stays. The concept of observation status was created, initially, as a clinical designation, primarily for Emergency Department (ED) clinicians to “observe” the patient for a period of time to determine the need for inpatient care (e.g., inpatient admission). Over the past three decades, observation status has evolved and now is used as an administrative assignment for patients who have a “short-term” hospital stay, typically falling “under the 2-midnight rule,” as originally defined for Medicare patients and now widely adopted by commercial insurers and Medicaid agencies. Our team recently found that observation stays are now common for pediatric hospital stays, especially for children undergoing surgery. For example, more than 50% of pediatric post-appendectomy admissions at Children's Hospitals were billed as observation stays in 2019. Studies from adult patients have found significant impact of omitting observation stay data on quality measures and financial implications of observation stays on patient Out-Of-Pocket (OOP) costs, yet there is a paucity of information about the impact and implications on pediatric patients. To fill the crucial knowledge gaps, we propose a retrospective observational study entitled Outcomes and Affordability of Observation Status for Children (OASIS) to characterize the shift in observation stay assignment of pediatric patients, evaluate the impact of omitting observation stay data on Pediatric Quality Indicators (QIs), and assess OOP costs for pediatric observation stays. We focus on Agency for Healthcare Research and Quality (AHRQ) Pediatric QIs and propose to evaluate the impact of omitting observation stay data on these QIs using Healthcare Cost and Utilization Project state specific databases from 2010 through 2019. Specifically, we will quantify the overall and specific trends in observation stay assignment by patient characteristic (e.g., race/ethnicity), evaluate the impact of omitting observation stay data on the Pediatric QIs, and examine if there are any disparities in the trends and QIs calculations. We also propose to assess OOP costs for pediatric observation stays by leveraging claims data from statewide All-Payer Claims Databases and Optum. We will first characterize unexpected OOP cost components that are typically covered by inpatient insurance benefits, such as medications, and identify conditions for which OOP costs are higher as an observation stay than as an inpatient stay. The OASIS study will provide pediatric specific evidence to refine quality measures, to develop advice for patients to recognize financial implications of observation stays on OOP costs, and to inform future policies to protect patients in observation stays from paying more than they would as inpatients.

项目弃权 据估计，每年在美国（美国）约有500,000（34％）的儿科医院住院 在“观察状态”下被指定为门诊病人，通常称为观察。概念 最初创建了观察状态，作为临床设计，急诊科（ED） 临床医生在一段时间内“观察”患者以确定需要住院护理的需求（例如，住院 入场）。在过去的三十年中，观察状态已经发展，现在被用作行政 对于有“短期”住院住院的患者的分配，通常是“ 2米夜规则”的分配， 最初定义为Medicare患者，现在被商业保险和医疗补助广泛采用 机构。我们的团队最近发现，观察目前在儿科医院住宿现在很常见， 特别是对于接受手术的儿童。例如，超过50％的小儿诊断后切除术 在2019年观察时，对儿童医院的入院被收费。成人患者的研究 发现省略观察停留数据对质量措施和财务影响的重大影响 观察保持在患者自付费用（OOP）费用上，但有关影响的信息很少 以及对小儿患者的影响。为了填补关键的知识差距，我们提出了回顾性 观察性研究名为儿童（OASIS）的结果和可承受的观察状态（OASIS） 表征儿科患者的观察停留分配的变化，评估省略的影响 观察小儿质量指标（QIS）的观察数据和小儿观察的评估成本 留下来。我们专注于医疗保健研究与质量机构（AHRQ）儿科QIS和提议 使用医疗保健成本和利用率评估省略观察停留数据对这些QI的影响 从2010年到2019年，项目状态特定的数据库。特别是，我们将量化整体和特定的数据库 观察趋势由患者特征（例如种族/种族）造成的观察务件分配，评估 省略有关小儿质量质量质量的观察数据，并检查趋势和 QIS计算。我们还建议通过利用索赔来评估小儿观察的OOP费用 来自全州全付款人的数据声称数据库和optum。我们首先将表征意外的OOP成本 通常由住院保险福利（例如药物）覆盖的组件，并确定 与住院住院相比，OOP成本作为观察住院的条件要高。绿洲研究 将提供小儿具体证据来完善质量措施，以为患者提供建议 观察的财务影响是对OOP成本的保留，并告知未来政策以保护患者 观察得出的支付比住院患者更多。