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Outcomes associated with observation stays versus inpatient admissions for pulmonary embolism

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Abstract

Changes in reimbursement policies have led to an increased use of observation stays in the United States (US). We sought to compare outcomes among pulmonary embolism (PE) patients managed through observation stays or inpatient admissions.The Premier Perspective Comparative Hospital Database was used to identify patients with a primary International Classification of Diseases, ninth-edition diagnosis of PE (415.1×) from 11/2012–3/2015. Patients were required to have claims for ≥1 diagnostic tests for PE on days 0–2 and evidence of PE treatment. Patients managed through observation stays were 1:1 propensity score matched to those undergoing inpatient admissions. We compared length-of-stay (LOS), hospital costs (2015US$) and rates of hospital-acquired conditions and readmission between the cohorts. A total of 1105 PE observation stays were matched to 1105 inpatient admissions. The baseline characteristics of the cohorts were well-balanced (no standardized differences >10 %). Mean ± standard deviation LOS and hospital costs were 3.6 ± 2.6 days and $5423 ± $5770, respectively. LOS was shorter for observation stays 2.3 ± 1.3 days) vs. inpatient admissions (4.9 ± 3.0 days, p < 0.001). This corresponded to a mean $4390 lower treatment costs for observation stays (p < 0.001). Hospital-acquired conditions were less common among observation stay patients vs. inpatients (p < 0.001); driven predominantly by reductions in bacterial pneumonia and Clostridium difficile infection. Readmission for venous thromboembolism or major bleeding in the same or subsequent 2-months did not differ between the cohorts (p ≥ 0.16 for both).Compared with inpatient admissions, observation stays were associated with reduced LOS, costs and hospital-acquired conditions, without increased risk of readmission.

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Funding

This study was funded by Janssen Scientific Affairs, LLC, Raritan, NJ, USA.

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Correspondence to Craig I. Coleman.

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Conflicts of Interest

Dr. Coleman has received grant funding and consultancy fees from Janssen Pharmaceuticals; Bayer Pharma AG and Boehringer-Ingelheim Pharmaceuticals, Inc. Mrs. Ashton and Drs. Crivera, Schein, and Wildgoose are employees of Janssen Scientific Affairs LLC. Dr. Peacock has received grant funding and consultancy fees from Janssen Pharmaceuticals and Portola. Dr. Fermann has received grant funding for Pfizer and is on the advisory board and speaker’s bureau for Janssen Pharmaceuticals. Dr. Wells has received grant funding from Bristol Myers Squib and Pfizer, is on the advisory board and has received speaker’s fees from Bayer Healthcare, has received consultancy fees from Janssen Pharmaceuticals, and served on a writing committee with Itreas. Drs. Weeda and Bunz have no conflict of interest to report.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. For this type of study, formal consent is not required. It should also be noted that all data were de-identified; thus, our study was exempted from institutional review board oversight. This article does not contain any studies with animals performed by any of the authors.

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Weeda, E.R., Peacock, W.F., Fermann, G.J. et al. Outcomes associated with observation stays versus inpatient admissions for pulmonary embolism. J Thromb Thrombolysis 42, 513–519 (2016). https://doi.org/10.1007/s11239-016-1391-y

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