Resource utilization for observation-status stays at children's hospitals.

Abstract:

BACKGROUND AND OBJECTIVE:Observation status, in contrast to inpatient status, is a billing designation for hospital payment. Observation-status stays are presumed to be shorter and less resource-intensive, but utilization for pediatric observation-status stays has not been studied. The goal of this study was to describe resource utilization characteristics for patients in observation and inpatient status in a national cohort of hospitalized children in the Pediatric Health Information System. METHODS:This study was a retrospective cohort from 2010 of observation- and inpatient-status stays of ≤2 days; all children were admitted from the emergency department. Costs were analyzed and described. Comparison between costs adjusting for age, severity, and length of stay were conducted by using random-effect mixed models to account for clustering of patients within hospitals. RESULTS:Observation status was assigned to 67 230 (33.3%) discharges, but its use varied across hospitals (2%-45%). Observation-status stays had total median costs of $2559, including room costs and $678 excluding room costs. Twenty-five diagnoses accounted for 74% of stays in observation status, 4 of which were used for detailed analyses: asthma (n = 6352), viral gastroenteritis (n = 4043), bronchiolitis (n = 3537), and seizure (n = 3289). On average, after risk adjustment, observation-status stays cost $260 less than inpatient-status stays for these select 4 diagnoses. Large overlaps in costs were demonstrated for both types of stay. CONCLUSIONS:Variability in use of observation status with large overlap in costs and potential lower reimbursement compared with inpatient status calls into question the utility of segmenting patients according to billing status and highlights a financial risk for institutions with a high volume of pediatric patients in observation status.

journal_name

Pediatrics

journal_title

Pediatrics

authors

Fieldston ES,Shah SS,Hall M,Hain PD,Alpern ER,Del Beccaro MA,Harding J,Macy ML

doi

10.1542/peds.2012-2494

subject

Has Abstract

pub_date

2013-06-01 00:00:00

pages

1050-8

issue

6

eissn

0031-4005

issn

1098-4275

pii

peds.2012-2494

journal_volume

131

pub_type

杂志文章,多中心研究
  • Prevalence and natural history of cryptorchidism.

    abstract:OBJECTIVE:A prospective hospital-based cohort study was conducted to determine the prevalence rates of cryptorchidism at birth, 3 months, and 1 year of age. DESIGN:A total of 6935 consecutive male neonates delivered at Mount Sinai Hospital in New York City between October 1987 and October 1990 were examined at birth f...

    journal_title:Pediatrics

    pub_type: 杂志文章

    doi:

    authors: Berkowitz GS,Lapinski RH,Dolgin SE,Gazella JG,Bodian CA,Holzman IR

    更新日期:1993-07-01 00:00:00

  • Quality of primary care and subsequent pediatric emergency department utilization.

    abstract:OBJECTIVE:Our objective was to determine whether parent-reported, high-quality primary care was associated with decreased nonurgent pediatric emergency department utilization. METHODS:A retrospective analysis of prospectively collected data for a cohort of children from the 2000-2001 and 2001-2002 Medical Expenditure ...

    journal_title:Pediatrics

    pub_type: 杂志文章

    doi:10.1542/peds.2006-3518

    authors: Brousseau DC,Hoffmann RG,Nattinger AB,Flores G,Zhang Y,Gorelick M

    更新日期:2007-06-01 00:00:00

  • Predictors of Medication Continuity in Children With ADHD.

    abstract:OBJECTIVES:To identify predictors of attention-deficit/hyperactivity disorder (ADHD) medication continuity, hypothesizing greater continuity among children with (1) greater child acceptance of treatment, (2) parent belief in longer time course for ADHD, (3) positive differential between parent-perceived need for and co...

    journal_title:Pediatrics

    pub_type: 杂志文章

    doi:10.1542/peds.2017-2580

    authors: Brinkman WB,Sucharew H,Majcher JH,Epstein JN

    更新日期:2018-06-01 00:00:00

  • Chylothorax in infants and children.

    abstract::Chylothorax, the accumulation of chyle in the pleural space, is a relatively rare cause of pleural effusion in children. It can cause significant respiratory morbidity, as well as lead to malnutrition and immunodeficiency. Thus, a chylothorax requires timely diagnosis and treatment. This review will first discuss the ...

    journal_title:Pediatrics

    pub_type: 杂志文章,评审

    doi:10.1542/peds.2013-2072

    authors: Tutor JD

    更新日期:2014-04-01 00:00:00

  • A randomized, clinical trial of a home safety intervention based in an emergency department setting.

    abstract:OBJECTIVE:To assess the effectiveness of an emergency department (ED)-based home safety intervention on caregivers' behaviors and practices related to home safety. METHODS:We conducted a randomized, clinical trial of 96 consecutive caregivers of children who were younger than 5 years and presented to an urban pediatri...

    journal_title:Pediatrics

    pub_type: 临床试验,杂志文章,随机对照试验

    doi:10.1542/peds.113.6.1603

    authors: Posner JC,Hawkins LA,Garcia-Espana F,Durbin DR

    更新日期:2004-06-01 00:00:00

  • Preterm Birth and Poor Fetal Growth as Risk Factors of Attention-Deficit/ Hyperactivity Disorder.

    abstract:BACKGROUND:Previous studies have shown an association between prematurity and attention- abstract deficit/hyperactivity disorder (ADHD). Results concerning late preterm infants are controversial, and studies examining fetal growth represented by weight for gestational age are scarce. Our objective was to examine the as...

    journal_title:Pediatrics

    pub_type: 杂志文章

    doi:10.1542/peds.2015-1043

    authors: Sucksdorff M,Lehtonen L,Chudal R,Suominen A,Joelsson P,Gissler M,Sourander A

    更新日期:2015-09-01 00:00:00

  • Aspirin and acetaminophen: a comparative view of their antipyretic and analgesic activity.

    abstract::Aspirin and acetaminophen have excellent and essentially similar antipyretic activity. For the child, lowering of temperature will be indicated for excessively high temperature and when there is a history of febrile seizures. Specific clinical contraindications will often dictate the selection of one drug over the oth...

    journal_title:Pediatrics

    pub_type: 杂志文章,评审

    doi:

    authors: Lovejoy FH Jr

    更新日期:1978-11-01 00:00:00

  • Short-term efficacy of oral dimercaptosuccinic acid in children with low to moderate lead intoxication.

    abstract:OBJECTIVE:To determine the short-term efficacy of meso-2,3-dimercaptosuccinic acid (DMSA) in mild to moderately lead poisoned children. METHODS:Medical records of all pediatric patients receiving 19 days of DMSA between June 1991 and May 1993 were reviewed retrospectively. Patients were included if their pretreatment ...

    journal_title:Pediatrics

    pub_type: 杂志文章

    doi:

    authors: Besunder JB,Anderson RL,Super DM

    更新日期:1995-10-01 00:00:00

  • Increased rates of morbidity, mortality, and charges for hospitalized children with public or no health insurance as compared with children with private insurance in Colorado and the United States.

    abstract:BACKGROUND:There has been a gradual decrease in the proportion of children covered by private health insurance in Colorado and the United States with a commensurate increase in those with public insurance or having no insurance which may impact access to care and outcomes. OBJECTIVE:The purpose of this work was to det...

    journal_title:Pediatrics

    pub_type: 杂志文章

    doi:10.1542/peds.2006-0162

    authors: Todd J,Armon C,Griggs A,Poole S,Berman S

    更新日期:2006-08-01 00:00:00

  • Neisseria meningitidis bacteremia in children: quantitation of bacteremia and spontaneous clinical recovery without antibiotic therapy.

    abstract::The relationship between the magnitude of bacteremia due to Neisseria meningitidis and the clinical diagnosis was determined for 43 children who had fever in the presence or absence of focal signs of infection. Bacteremia was quantitated by the previously described procedure using heparinized blood (0.2 to 1.0 mL). Ad...

    journal_title:Pediatrics

    pub_type: 杂志文章

    doi:

    authors: Sullivan TD,LaScolea LJ Jr

    更新日期:1987-07-01 00:00:00

  • Trends in mortality and morbidity for very low birth weight infants, 1991-1999.

    abstract:BACKGROUND:Medical care for very low birth weight (VLBW) infants and their mothers has changed dramatically during the 1990s, yet it is unclear how these changes have affected mortality and morbidity. OBJECTIVE:We used the Vermont Oxford Network Database to identify trends in clinical practice and patient outcomes for...

    journal_title:Pediatrics

    pub_type: 杂志文章,多中心研究

    doi:10.1542/peds.110.1.143

    authors: Horbar JD,Badger GJ,Carpenter JH,Fanaroff AA,Kilpatrick S,LaCorte M,Phibbs R,Soll RF,Members of the Vermont Oxford Network.

    更新日期:2002-07-01 00:00:00

  • Successful treatment of type 1 diabetes and seizures with combined ketogenic diet and insulin.

    abstract::Diabetic ketoacidosis (DKA) is a life-threatening condition and a major cause of morbidity and mortality in children with type 1 diabetes mellitus. The deficiency of insulin leads to metabolic decompensation, causing hyperglycemia and ketosis that resolves with the administration of insulin and fluids. However, an ind...

    journal_title:Pediatrics

    pub_type: 杂志文章

    doi:10.1542/peds.2011-0741

    authors: Aguirre Castaneda RL,Mack KJ,Lteif A

    更新日期:2012-02-01 00:00:00

  • Recommendations for influenza immunization of children.

    abstract::Epidemiologic studies indicate that children of all ages with certain chronic conditions and otherwise healthy children younger than 24 months of age are hospitalized for influenza infection and its complications at high rates similar to those experienced by the elderly. Annual influenza immunization is recommended fo...

    journal_title:Pediatrics

    pub_type: 指南,杂志文章,实务指引

    doi:10.1542/peds.113.5.1441

    authors: American Academy of Pediatrics Committee on Infectious Diseases.

    更新日期:2004-05-01 00:00:00

  • Adenovirus meningoencephalitis.

    abstract::Central nervous system manifestations in association with adenovirus infections have rarely been documented. In this report, four children, ages 4, 5, 6, and 10 years, with adenoviral meningoencephalitis are described. Adenoviruses were recovered from CSF specimens in all four patients. ...

    journal_title:Pediatrics

    pub_type: 杂志文章

    doi:

    authors: Kelsey DS

    更新日期:1978-02-01 00:00:00

  • Toward an Understanding of Advance Care Planning in Children With Medical Complexity.

    abstract:BACKGROUND AND OBJECTIVES:Children with medical complexity (CMC) often have multiple life-limiting conditions with no unifying diagnosis and an unclear prognosis and are at high risk for morbidity and mortality. Advance care planning (ACP) conversations need to be uniquely tailored to this population. Our primary objec...

    journal_title:Pediatrics

    pub_type: 杂志文章

    doi:10.1542/peds.2019-2241

    authors: Orkin J,Beaune L,Moore C,Weiser N,Arje D,Rapoport A,Netten K,Adams S,Cohen E,Amin R

    更新日期:2020-03-01 00:00:00

  • Health and mental health needs of children in US military families.

    abstract::The wars in Afghanistan and Iraq have been challenging for US uniformed service families and their children. Almost 60% of US service members have family responsibilities. Approximately 2.3 million active duty, National Guard, and Reserve service members have been deployed since the beginning of the wars in Afghanista...

    journal_title:Pediatrics

    pub_type: 杂志文章

    doi:10.1542/peds.2013-0940

    authors: Siegel BS,Davis BE,Committee on Psychosocial Aspects of Child and Family Health and Section on Uniformed Services.

    更新日期:2013-06-01 00:00:00

  • Temperament and behavior of preterm infants: a six-year follow-up.

    abstract::To test the commonly held premise that prematurity is a risk factor for problems of behavior and social interaction, as well as cognitive and physical development, temperament and behavior of children born preterm and full-term control subjects were compared at five separate time periods from infancy through early sch...

    journal_title:Pediatrics

    pub_type: 杂志文章

    doi:

    authors: Oberklaid F,Sewell J,Sanson A,Prior M

    更新日期:1991-06-01 00:00:00

  • Carbon monoxide is a significant mediator of cardiovascular status following preterm birth.

    abstract:OBJECTIVE:With male gender as a strong predictor of cardiovascular instability, we hypothesized that gender-specific differences in circulating carbon monoxide levels contributed to dysregulated microvascular function in preterm male infants. METHODS:Infants born at 24 to 34 weeks of gestation (N = 84) were studied in...

    journal_title:Pediatrics

    pub_type: 杂志文章

    doi:10.1542/peds.2008-0877

    authors: Stark MJ,Clifton VL,Wright IM

    更新日期:2009-07-01 00:00:00

  • Growth and development in a child with resistance to thyroid hormone and ectopic thyroid gland.

    abstract::Resistance to thyroid hormone is an uncommon problem, which has rarely been associated with thyroid dysgenesis. We report a case with both thyroid gland ectopy and resistance to thyroid hormone and, thus, a reduced capacity to produce and respond to thyroid hormone. The patient presented at 2 years of age with develop...

    journal_title:Pediatrics

    pub_type: 杂志文章

    doi:10.1542/peds.2011-0634

    authors: Heather N,Hall K,Neas K,Potter H,Wiltshire E

    更新日期:2012-03-01 00:00:00

  • Population-based impact of pneumococcal conjugate vaccine in young children.

    abstract:OBJECTIVE:To determine the population impact of pneumococcal conjugate vaccine (PCV) on pneumococcal-related diseases, including pneumonia and otitis media. METHODS:Using administrative data from Tennessee Medicaid and 3 commercial insurance plans in upstate New York, we measured annual rates of medical visits for pne...

    journal_title:Pediatrics

    pub_type: 杂志文章

    doi:10.1542/peds.2003-0592-F

    authors: Poehling KA,Lafleur BJ,Szilagyi PG,Edwards KM,Mitchel E,Barth R,Schwartz B,Griffin MR

    更新日期:2004-09-01 00:00:00

  • Addressing the mental health needs of pregnant and parenting adolescents.

    abstract::Adolescent parenthood is associated with a range of adverse outcomes for young mothers, including mental health problems such as depression, substance abuse, and posttraumatic stress disorder. Teen mothers are also more likely to be impoverished and reside in communities and families that are socially and economically...

    journal_title:Pediatrics

    pub_type: 杂志文章,评审

    doi:10.1542/peds.2013-0927

    authors: Hodgkinson S,Beers L,Southammakosane C,Lewin A

    更新日期:2014-01-01 00:00:00

  • The role of the nurse practitioner and physician assistant in the care of hospitalized children. American Academy of Pediatrics. Committee on Hospital Care.

    abstract::The positions of nurse practitioner and physician assistant were created approximately 30 years ago. Since then, the role and responsibilities of these individuals have developed and grown and now may include involvement in the care of hospitalized patients. The intent of this statement is to suggest a manner in which...

    journal_title:Pediatrics

    pub_type: 指南,杂志文章,实务指引

    doi:10.1542/peds.103.5.1050-a

    authors:

    更新日期:1999-05-01 00:00:00

  • Iodine deficiency, pollutant chemicals, and the thyroid: new information on an old problem.

    abstract::Many women of reproductive age in the United States are marginally iodine deficient, perhaps because the salt in processed foods is not iodized. Iodine deficiency, per se, can interfere with normal brain development in their offspring; in addition, it increases vulnerability to the effects of certain environmental pol...

    journal_title:Pediatrics

    pub_type: 杂志文章,评审

    doi:10.1542/peds.2014-0900

    authors: Council on Environmental Health.,Rogan WJ,Paulson JA,Baum C,Brock-Utne AC,Brumberg HL,Campbell CC,Lanphear BP,Lowry JA,Osterhoudt KC,Sandel MT,Spanier A,Trasande L

    更新日期:2014-06-01 00:00:00

  • Pulmonary vein stenosis: prematurity and associated conditions.

    abstract:OBJECTIVE:Pulmonary vein stenosis is a rare, although often lethal, anomaly. Risk factors for the diagnosis of pulmonary vein stenosis are poorly characterized. In this study we sought to identify factors associated with pulmonary vein stenosis, paying particular attention to preterm birth. METHODS:By review of the ca...

    journal_title:Pediatrics

    pub_type: 杂志文章

    doi:10.1542/peds.2008-0075

    authors: Drossner DM,Kim DW,Maher KO,Mahle WT

    更新日期:2008-09-01 00:00:00

  • Socioeconomic Status and Long-term Outcomes in Single Ventricle Heart Disease.

    abstract:BACKGROUND:Low socioeconomic status (SES) has emerged as an important risk factor for higher short-term mortality and neurodevelopmental outcomes in children with hypoplastic left heart syndrome and related anomalies; yet little is known about how SES affects these outcomes over the long-term. METHODS:We linked data f...

    journal_title:Pediatrics

    pub_type: 杂志文章,多中心研究,随机对照试验

    doi:10.1542/peds.2020-1240

    authors: Bucholz EM,Sleeper LA,Goldberg CS,Pasquali SK,Anderson BR,Gaynor JW,Cnota JF,Newburger JW

    更新日期:2020-10-01 00:00:00

  • Some Limitations for Early Diagnosis of Congenital Chagas Infection by PCR.

    abstract::Trypanosoma cruzi, the causing agent of Chagas disease, can be transmitted to the offspring of infected pregnant women, thus being an epidemiologically important way of parasite transmission in humans. In addition, the migration of infected women from endemic areas to nonendemic countries may export this parasite infe...

    journal_title:Pediatrics

    pub_type: 杂志文章

    doi:10.1542/peds.2016-3719

    authors: Volta BJ,Perrone AE,Rivero R,Scollo K,Bustos PL,Bua J

    更新日期:2018-04-01 00:00:00

  • Health information technology and the medical home.

    abstract::The American Academy of Pediatrics (AAP) supports development and universal implementation of a comprehensive electronic infrastructure to support pediatric information functions of the medical home. These functions include (1) timely and continuous management and tracking of health data and services over a patient's ...

    journal_title:Pediatrics

    pub_type: 杂志文章,评审

    doi:10.1542/peds.2011-0454

    authors: Council on Clinical Information Technology.

    更新日期:2011-05-01 00:00:00

  • Bedside diagnosis of influenzavirus infections in hospitalized children.

    abstract:OBJECTIVE:For preventing nosocomial influenza infections and to facilitate prompt antiviral therapy, an accessible, rapid diagnostic method for influenzavirus is needed. We evaluated the performance of a lateral-flow immunoassay (QuickVue Influenza Test) completed at the bedside of hospitalized children during the infl...

    journal_title:Pediatrics

    pub_type: 杂志文章

    doi:10.1542/peds.110.1.83

    authors: Poehling KA,Griffin MR,Dittus RS,Tang YW,Holland K,Li H,Edwards KM

    更新日期:2002-07-01 00:00:00

  • Imbalance between production and conjugation of bilirubin: a fundamental concept in the mechanism of neonatal jaundice.

    abstract:OBJECTIVE:The objective of this study was to evaluate the roles of production and conjugation of bilirubin, individually and in combination, in the mechanism of neonatal jaundice. METHODS:A cohort of healthy, term male newborns was sampled on the third day of life, coincident with routine metabolic screening, for bloo...

    journal_title:Pediatrics

    pub_type: 杂志文章

    doi:10.1542/peds.110.4.e47

    authors: Kaplan M,Muraca M,Hammerman C,Rubaltelli FF,Vilei MT,Vreman HJ,Stevenson DK

    更新日期:2002-10-01 00:00:00

  • Case of congenital short small intestine: survival with use of long-term parenteral feeding.

    abstract::Isolated congenital short small intestine is a rare anomaly. Of six (one male, five females) previously reported cases, four died in infancy from intractable diarrhea. We report the case of 7-year-old boy with this syndrome in whom a 2-year period of parenteral feeding at home allowed normal weight gain, growth, and d...

    journal_title:Pediatrics

    pub_type: 杂志文章

    doi:

    authors: Dorney SF,Byrne WJ,Ament ME

    更新日期:1986-03-01 00:00:00