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January 25, 2012

Hospital Readmissions and Measures of Quality—Reply

Author Affiliations

Author Affiliations: Philadelphia Veterans Affairs Medical Center, Philadelphia, Pennsylvania (Dr Kangovi) (kangovi@mail.med.upenn.edu); and Division of General Internal Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia (Dr Grande).

JAMA. 2012;307(4):361-362. doi:10.1001/jama.2012.12

In Reply: Dr Dardick and Ms Stein highlight the importance of considering observation status in discussions of hospital readmission. Our conceptual model (Figure in the article) focused on the determinants of reuse from hospital-based acute care to hospital readmission. Observation status represents another form of reuse of hospital-based acute care whose drivers can also be conceptualized from the same model.

Although observation services are hospital-based, they are classified by payers as outpatient services. Consequently, they are not counted toward a hospital's readmission rate. Therefore, we agree with Dardick and Stein and have emphasized the need to monitor changes in observation service use as readmission penalties are implemented. Penalties could serve as incentives for hospitals to increase the use of observation status as a way to provide patients with hospital-based acute care without readmitting them.

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