Objective(s): Despite a wide adoption of observation status policy for Medicare beneficiaries with diverse conditions across U.S., little is known about population-level changes in observation status use for children.This study aimed to examine statewide trends in observation status use for pediatric population.Methods: This repeated cross-sectional analysis used statewide hospital discharge data from six states from 2012 through 2019 to characterize inpatient and observation stays for patients <18 years old with conditions that may require short-term hospital stay (i.e., <3 days).The population-level use of observation status was measured by observation stay rate, defined as the number of observation stays per 100,000 children per year for each state.Population-level changes were examined using linear regressions with generalized estimating equations to account for within-state clustering.Subgroup analyses were conducted by patient demographics, neighborhood socioeconomic characteristics, diagnosis groups, chronic condition status, and length of stay.Results: Among 808,181 hospital stays, 299,483 (37.1%) were observation stays.From 2012 through 2019, observation stay rates increased in all six states, with an average annual growth of 17.8 (95% Confidence Interval (CI): 10.4-25.3)per 100,000 children.Observation stay rates significantly increased for children who were <6 years old, non-White, and publicly insured.Red blood cell disorders had the fast-growing use of observation status, with a percentage increase of 25.7% (95%CI: 18.6%-33.3%). Conclusion:Although descriptive, we found substantial yet differential increases in observationstatus use among children, especially for younger, non-White, publicly insured children and for conditions previously cared under an inpatient designation, using multi-state population-level data.Medicare beneficiaries. 233]4 Despite its Medicare origin, many private insurers as well as Medicaid and Children's Health Insurance Program (CHIP) programs have adopted similar rules
Tian et al. (Fri,) studied this question.