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{
    "pk": 8581,
    "title": "Variability in the Initial Costs of Care and One-Year Outcomes of Observation Services",
    "subtitle": null,
    "abstract": "Introduction:\n The use of observation units (OUs) following emergency departments (ED) visits as a model of care has increased exponentially in the last decade. About one-third of U.S. hospitals now have OUs within their facilities. While their use is associated with lower costs and comparable level of care compared to inpatient units, there is a wide variation in OUs characteristics and operational procedures. The objective of this research was to explore the variability in the initial costs of care of placing patients with non-specific chest pain in observation units (OUs) and the one-year outcomes.\nMethods: \nThe author retrospectively investigated medical insurance claims of 22,962 privately insured patients (2009-2011) admitted to 41 OUs. Outcomes included the one-year chest pain/cardiovascular related costs and primary and secondary outcomes. Primary outcomes included myocardial infarction, congestive heart failure, stroke or cardiac arrest, while secondary outcomes included revascularization procedures, ED revisits for angina pectoris or chest pain and hospitalization due to cardiovascular diseases. The author aggregated the adjusted costs and prevalence rates of outcomes for patients over OUs, and computed the weighted coefficients of variation (WCV)  to compare variations across OUs.\nResults: \nThere was minimal variability in the initial costs of care (WCV=2.2%), while the author noticed greater variability in the outcomes. Greater variability were associated with the adjusted cardiovascular-related costs of medical services (WCV=17.6%) followed by the adjusted prevalence odds ratio of patients experiencing primary outcomes (WCV=16.3%) and secondary outcomes (WCV=10%).\nConclusion: \nHigher variability in the outcomes suggests the need for more standardization of the observation services for chest pain patients. [West J Emerg Med. 2015;16(3):395–400.]",
    "language": "en",
    "license": {
        "name": "Creative Commons Attribution 4.0",
        "short_name": "CC BY 4.0",
        "text": "Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.\r\n\r\nNo additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.",
        "url": "https://creativecommons.org/licenses/by/4.0"
    },
    "keywords": [
        {
            "word": "Observation Units, Costs of Care, Variation, Outcomes"
        }
    ],
    "section": "Health Outcomes",
    "is_remote": true,
    "remote_url": "https://escholarship.org/uc/item/26n926sb",
    "frozenauthors": [
        {
            "first_name": "Ibrahim",
            "middle_name": "",
            "last_name": "Abbass",
            "name_suffix": "",
            "institution": "University of Texas School of Public Health, Houston, Texas",
            "department": "None"
        }
    ],
    "date_submitted": "2014-10-16T20:11:56Z",
    "date_accepted": "2014-10-16T20:11:56Z",
    "date_published": "2015-04-10T21:21:08Z",
    "render_galley": null,
    "galleys": [
        {
            "label": "",
            "type": "pdf",
            "path": "https://journalpub.escholarship.org/westjem/article/8581/galley/4948/download/"
        }
    ]
}