Outcomes and Affordability of Observation Status for Children (OASIS)

项目简介 据估计，美国每年约有50万（34%）儿科住院， 在“观察状态”下被指定为门诊病人，并且通常被称为观察停留。的概念 观察状态最初是作为临床名称创建的，主要用于急诊科（艾德） 临床医生“观察”患者一段时间以确定住院护理的需要（例如，住院 入场）。在过去三十年中，观察员地位不断演变，现在被用作一种行政手段， 分配给“短期”住院的病人，通常属于“午夜2点规则”， 最初是为医疗保险患者定义的，现在被商业保险公司和医疗补助计划广泛采用 社.我们的团队最近发现，观察住院现在是常见的儿科住院， 特别是对于接受手术的儿童。例如，超过50%的小儿阑尾切除术后 2019年，儿童医院的入院被列为观察停留。对成年患者的研究表明， 发现忽略观察停留数据对质量措施和财务影响的重大影响， 观察停留在患者自付（OOP）成本上，但有关影响的信息很少 以及对儿科患者的影响。为了填补关键的知识空白，我们提出了一个回顾 一项名为“儿童观察状态的结局和负担能力”（OASIS）的观察性研究， 描述儿科患者观察住院时间分配的变化，评价省略 儿科质量指标（QIs）的观察停留数据，并评估儿科观察的OOP成本 留下来我们专注于医疗保健研究和质量机构（AHRQ）儿科质量指标，并建议 使用医疗保健成本和利用率评估省略观察住院数据对这些质量指标的影响 从2010年到2019年的项目状态特定数据库。具体而言，我们将量化整体和具体 通过患者特征的观察停留分配的趋势（例如，种族/民族），评估 忽略儿科QIs的观察停留数据，并检查趋势是否存在任何差异， QIs计算。我们还建议通过利用索赔来评估儿科观察住院的OOP成本 数据来自全州所有付款人索赔数据库和Optum。我们将首先描述意外OOP成本 住院保险福利通常涵盖的组成部分，如药物，并确定 OOP费用作为观察住院比作为住院更高的条件。OASIS研究 将提供儿科的具体证据，以完善质量措施，为患者提供建议， 观察停留对OOP成本的财务影响，并为未来的政策提供信息，以保护 观察期的病人不会比住院病人支付更多的费用。

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.