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.

项目摘要 据估计，美国 (US) 每年约有 500,000 例 (34%) 儿科住院患者 指定为“观察状态”下的门诊患者，通常称为观察住院的概念。 观察状态最初是作为临床指定而创建的，主要用于急诊科 (ED) 追随者“观察”患者一段时间，以确定是否需要住院护理（例如，住院治疗） 在过去的三十年里，观察状态发生了变化，现在被用作行政手段。 为“短期”住院的患者进行分配，通常属于“午夜 2 点规则”，例如 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广泛采用 我们的团队最近发现，儿童住院观察现在很常见， 尤其是对于接受手术的儿童，例如超过 50% 的儿科阑尾切除术后。 2019 年儿童医院的入院病例被计为观察期。针对成年患者的研究表明 发现省略观察停留数据对质量措施和财务影响有重大影响 观察停留在患者自付费用 (OOP) 上，但有关其影响的信息却很少 以及对儿科患者的影响为了填补关键的知识空白，我们提出了一项回顾性研究。 题为“儿童观察状态的结果和承受能力”（OASIS）的观察性研究 描述儿科患者观察任务停留时间的变化，评估省略的影响 儿科质量指标 (QI) 的观察停留数据，并评估儿科观察的 OOP 成本 我们关注医疗保健研究和质量机构 (AHRQ) 儿科 QI，并建议： 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 项目状态特定数据库从 2010 年到 2019 年。具体来说，我们将量化总体和具体 按患者特征（例如种族/民族）划分的观察时间分配趋势，评估以下因素的影响 省略儿科 QI 的观察停留数据，并检查趋势和数据是否存在差异 我们还建议通过利用索赔来评估儿科观察住院的 OOP 成本。 来自联邦全付款人索赔数据库和 Optum 的数据 我们将首先描述意外的 OOP 成本。 通常由住院保险福利承保的组成部分，例如药物，并确定 OASIS 研究显示，观察期间的 OOP 费用高于住院费用。 将提供儿科具体证据来完善质量措施，为患者制定建议以认识到 观察对 OOP 成本的财务影响，并为未来保护患者的政策提供信息 观察期间无需支付比住院患者更多的费用。