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Quality Improvement of Care Transitions and the Trend of Composite Hospital Care

Giffin W. Daughtridge1; Traci Archibald, OTR/L, MBA2; Patrick H. Conway, MD, MSCE2,3
[+] Author Affiliations
1University of Pennsylvania, Philadelphia
2Centers for Medicare & Medicaid Services, Baltimore, Maryland
3Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
JAMA. 2014;311(10):1013-1014. doi:10.1001/jama.2014.509.
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The prevalence and length of observation stays, defined by the US Department of Health and Human Services as short-term treatments provided to outpatients to determine whether beneficiaries require treatment as inpatients or can be discharged, has increased, with a concurrent reduction in hospitalizations.1 However, the magnitude of these shifts has not been quantified. As the Centers for Medicare & Medicaid Services (CMS) implements payment reductions to hospitals for high rates of rehospitalizations and funds quality improvement initiatives focused on better care coordination and reducing unplanned returns to the hospital, it is important to understand the composite effect on hospitalizations (defined as any admission to the inpatient service of a hospital) and observation stays at the population level.

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Hospitalizations and Observation Days, Rehospitalizations and Observation Days Within 30 Days of Discharge, and Composite Rates for Both, per 1000 Medicare Fee-for-Service (FFS) Beneficiaries, Between July 2009 and June 2013

Observation stays were identified by any claim submitted for a Medicare patient treated in observation status. Composite percent change: 5.7% (panel A) and 11.1% (panel B). Data from Medicare Part A claims.

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