Table 1.
Key patient and hospital characteristics of Medicare observation patients from January 1, 2014 to November 30, 2014 by neighborhood socioeconomic disadvantage.a
| Key Characteristic | Overall (n=319,980) | Least Disadvantaged 85% (n=278,005) | Most Disadvantaged 15% (n=41,975) |
|---|---|---|---|
| Patients | |||
| Age, y — mean ±SD | 73.03±13.66 | 73.73±13.29 | 68.36±15.07 |
| >=65 y — no. (%) | 253,419 (79.2) | 226,397 (81.4) | 27,022 (64.4) |
| >=80 y — no. (%) | 106,023 (33.1) | 96,143 (34.6) | 9,880 (23.5) |
| Female — no. (%) | 188,702 (59.0) | 163,427 (58.8) | 25,275 (60.2) |
| Race — no. (%) | |||
| White | 254,135 (79.4) | 229,517 (82.6) | 24,618 (58.7) |
| African-American | 40,913 (12.8) | 27,726 (10.0) | 13,187 (31.4) |
| Other race | 23,795 (7.4) | 19,704 (7.1) | 4,091 (9.8) |
| Unknown race | 1,137 (0.4) | 1,058 (0.4) | 79 (0.2) |
| Medicaid — no. (%) | 87,302 (27.3) | 66,407 (23.9) | 20,895 (49.8) |
| Disabled — no. (%) | 101,477 (31.7) | 80,764 (29.1) | 20,713 (49.4) |
| Rural-urban commuting area for patient residence — no (%) | |||
| Urban core area | 204,600 (63.9) | 180,431 (64.9) | 24,169 (57.6) |
| Suburban area | 31,721 (9.9) | 29,080 (10.5) | 2,641 (6.3) |
| Large rural area | 42,027 (13.1) | 34,622 (12.5) | 7,405 (17.6) |
| Small town/isolated rural | 41,412 (12.9) | 33,693 (12.1) | 7,719 (18.4) |
| Unknown area | 220 (0.1) | 179 (0.1) | 41 (0.1) |
| Hierarchical condition category score — mean ±SD | 2.28±1.76 | 2.24±1.74 | 2.49±1.90 |
| Observation stays in year prior — mean ±SD | 0.71±2.67 | 0.65±2.20 | 1.07±4.71 |
| Comorbid conditions in year priorb — no. (%) | |||
| Hypertension | 226,490 (70.8) | 194,246 (69.9) | 32,244 (76.8) |
| Uncomplicated diabetes | 102,137 (31.9) | 85,087 (30.6) | 17,050 (40.6) |
| Fluid and electrolyte disorders | 92,721 (29.0) | 78,346 (28.2) | 14,375 (34.3) |
| Chronic pulmonary disease | 90,149 (28.2) | 75,004 (27.0) | 15,145 (36.1) |
| Deficiency Anemia | 87,525 (27.4) | 73,817 (26.6) | 13,708 (32.7) |
| Hypothyroidism | 63,426 (19.8) | 55,756 (20.1) | 7,670 (18.3) |
| Depression | 62,061 (19.4) | 52,226 (18.8) | 9,835 (23.4) |
| Congestive heart failure | 60,045 (18.8) | 50,065 (18.0) | 9,980 (23.8) |
| Renal Failure | 59,971 (18.7) | 50,286 (18.1) | 9,685 (23.1) |
| Other neurologic disorders | 53,895 (16.8) | 45,996 (16.6) | 7,899 (18.8) |
| Peripheral vascular disease | 46,533 (14.5) | 39,603 (14.3) | 6,930 (16.5) |
| Obesity | 44,946 (14.1) | 36,895 (13.3) | 8,051 (19.2) |
| Valvular disease | 36,369 (11.4) | 32,152 (11.6) | 4,217 (10.1) |
| Complicated diabetes | 32,762 (10.2) | 26,657 (9.6) | 6,105 (14.5) |
| Primary diagnosis of index observation stayc — no. (%) | |||
| Congestive heart failure | 40,685 (12.7) | 34,458 (12.4) | 6,227 (14.8) |
| Acute myocardial infarction | 1,276 (0.4) | 1,094 (0.4) | 182 (0.4) |
| Pneumonia | 4,288 (1.3) | 3,646 (1.3) | 642 (1.5) |
| COPD | 52,286 (16.3) | 43,844 (15.8) | 8,442 (20.1) |
| Length of stay of index observation stay, d — mean ±SD | 1.23±0.64 | 1.23±0.64 | 1.24±0.65 |
| 1 d | 267,940 (83.7) | 233,053 (83.8) | 34,887 (83.1) |
| 2 d | 35,811 (11.2) | 31,042 (11.2) | 4,769 (11.4) |
| 3 d | 12,504 (3.9) | 10,742 (3.9) | 1,762 (4.2) |
| >=4 d | 3,725 (1.2) | 3,168 (1.1) | 557 (1.3) |
| Observation stay originated from ED visit — no. (%) | 253,192 (79.1) | 220,424 (79.3) | 32,768 (78.1) |
| Discharged to skilled-nursing facility — no. (%) | 14,265 (4.5) | 12,742 (4.6) | 1,523 (3.6) |
| Index hospital | |||
| Medical school affiliation — no. (%) | |||
| Major medical school | 64,952 (20.3) | 55,204 (19.9) | 9,748 (23.2) |
| Minor medical school | 75,473 (23.6) | 65,276 (23.5) | 10,197 (24.3) |
| No medical school | 179,442 (56.1) | 157,412 (56.6) | 22,030 (52.5) |
| Unknown medical school | 113 (<0.1) | 113 (<0.1) | 0 (0.0) |
| Hospital type — no. (%) | |||
| Nonprofit, public hospital | 280,503 (87.7) | 244,919 (88.1) | 35,584 (84.8) |
| Nonprofit hospital | 229,888 (71.8) | 202,192 (72.7) | 27,696 (66.0) |
| Public hospital | 50,502 (15.8) | 42,614 (15.3) | 7,888 (18.8) |
| For-profit hospital | 38,241 (12.0) | 32,016 (11.5) | 6,225 (14.8) |
| Annual total discharge volumed, n — mean ±SD | 5,399±4,642 | 5,428±4,662 | 5,209±4,508 |
| Highest tertile — no. (%) | 234,514 (73.3) | 205,068 (73.8) | 29,446 (70.2) |
| Middle tertile — no. (%) | 65,077 (20.3) | 55,876 (20.1) | 9,201 (21.9) |
| Lowest tertile — no. (%) | 20,389 (6.4) | 17,061 (6.1) | 3,328 (7.9) |
| 30-d patient outcomes— no. (%) | |||
| 30-day re-observation | 16,400 (5.1) | 13,543 (4.9) | 2,857 (6.8) |
ED: emergency department; COPD: chronic obstructive lung disease; AIDS: Acquired Immune Deficiency Syndrome.
a
Neighborhood disadvantage as measured by Area Deprivation Index (ADI).
b
Comorbidities per Elixhauser methods.
c
Per Medicare readmission measure definitions.
d
Total number of patient discharges per hospital in 2013 reflects hospital size and census.