28 Aug ‘Observation Stays’ vs Hospitalzations for Ambulatory Care–Sensitive Conditions
MedicalResearch.com Interview with:
Jose F. Figueroa, MD, MPH
Instructor , Harvard Medical School,
Department of Medicine
Brigham and Women’s Hospital
MedicalResearch.com: What is the background for this study?
Response: Hospitalizations related to ambulatory-care sensitive conditions are widely considered a key measure of access to high-quality ambulatory care. It is included as a quality measure in many national value-based care programs. To date, we do not really know whether rates of these avoidable hospitalizations are meaningfully improving for Medicare beneficiaries over time.
MedicalResearch.com: What are the main findings?
Response: Our main findings of the study show that rates of avoidable hospitalizations are improving over time. However, we also find that hospitals are increasingly shifting patients to observation status for these same conditions.
Therefore, our results suggest that much of the improvement in reducing avoidable hospitalizations among Medicare patients is probably not due to better quality of care in the ambulatory setting. Instead, it appears that reductions in hospitalizations are more related to hospitals admitting fewer patients under inpatient status and instead more of them into observation status.
MedicalResearch.com: What should readers take away from your report?
Response: Our findings raise concern that changes in care in the ambulatory setting does not appear to be a major contributor to improvements in reducing the number of avoidable hospitalizations.
MedicalResearch.com: What recommendations do you have for future research as a result of this work?
Response: There are a lot of quality measures in value-based programs, like accountable care organizations, that include rates of hospitalizations for ACSCs as a quality measure, which are tied to financial incentives. Our work suggests that if these programs are interested in reducing rates of avoidable acute care visits to the hospital, they should re-evaluate the measure and expand it to include observation visits and potentially ED visits as well.
MedicalResearch.com: Is there anything else you would like to add?
Response: We do not have any disclosures to report beyond funding. Jose Figueroa was partially funded to do this work by a grant from the National Center for Advancing Translational Sciences, KL2-TR002542.
Figueroa JF, Burke LG, Zheng J, Orav EJ, Jha AK. Trends in Hospitalization vs Observation Stay for Ambulatory Care–Sensitive Conditions. JAMA Intern Med. Published online August 26, 2019. doi:10.1001/jamainternmed.2019.3177
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